HB 1047 — Department of Health

authorizinghb1047-02-c2 theF boardL toO establishR certainI standardsD ofA care;H O U S E O F R E P R E S E N T A T I V E S CS/CS/HB 1047 2018 providing definitions;

providing legislative intent;

prohibiting health care facilities and insurers from requiring certifications as conditions of licensure, reimbursement, or admitting privileges;

providing exceptions;

providing construction;

459.022, F.S.;

requiring a licensed physician assistant to report any changes in his or her supervising physician or designated supervising physician within a specified time;

requiring a designated supervising physician to maintain a list of approved supervising physicians at a facility or practice;

amending s.

460.408, F.S.;

defining the term "contact classroom hour";

revising provisions relating to continuing chiropractic education requirements;

repealing s.

460.4166, F.S., relating to registered chiropractic assistants;

amending s.

requiring the boardBoard of Nursing to establishadopt by rule discipline and standards of care underfor the scope of practice of certified nursing assistants;

revising grounds for board-imposedboard- imposed disciplinary sanctions;

requiring an institutional pharmacy to pass an onsite inspection by the department within a specified time before the issuance of an initial permit or a Page 13 of 6080 CODING:

hb1047-01-c1hb1047-02-c2 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/HBCS/CS/HB 1047 2018 institutionalpermit pharmacy to pass inspection by the board for certainchange permits;of location;

requiring a nuclear pharmacy to pass aan specifiedonsite inspection by the department within a specified time before issuance of certainan permits;initial permit or a permit for change of location;

requiring certain pharmacies and outsourcing facilities located in this state to obtain a permit in order to create, ship, mail, deliver, or dispense compounded sterile products into this state;

authorizing the boardBoard of Pharmacy to adopt certain rules;

requiring a special pharmacy to pass an onsite inspection by the boarddepartment within a specified time before the issuance of an initial permit or a permit for certainchange permits;of location;

requiring an Internet pharmacy to pass an onsite inspection by department within a specified time before the boardissuance of an initial permit or a permit for certainchange permits;of location;

465.0235, F.S.;

providing that a community pharmacy may use automated pharmacy systems under certain circumstances;

amending s.

revising certain requirements for examinations to be completed by applicants seeking dentalPage licensure;4 of 80 CODING:

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hb1047-02-c2 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HB 1047 2018 dental licensure;

revising requirements for examinations of a dental hygienist;hygienists;

providing for disciplinary action by the board;Board of Dentistry;

authorizing the Boardboard of Dentistry to adopt rules;

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hb1047-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/HB 1047 2018 repealing s.

466.032, F.S., relating to registration;

repealing s.

466.033, F.S., relating to registration certificates;

repealing s.

466.034, F.S., relating to change of ownership or address;

repealing s.

466.035, F.S., relating to advertising;

repealing s.

466.036, F.S., relating to information, periodic inspections, and equipment and supplies;

repealing s.

466.037, F.S., relating to suspension and revocation and administrative fines;

repealing s.

466.038, F.S., relating to rules;

repealing s.

466.039, F.S., relating to violations;

466.031, F.S.;

expanding the definition of the term "dental laboratory" to include any person, firm, or corporation who performs an onsite consultation during dental procedures;

amending s.

466.036, F.S.;

revising inspection frequency of dental laboratories during a specified period;

amending s.

providing that certain persons are not prohibited or restricted from his or her practice, services, or activities;activities in dietetics and nutrition;

revising requirements for the renewal of a license relatedrelating to continuing education;

revisingPage qualifications5 forof licensure80 asCODING: a massage therapist;

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hb1047-02-c2 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HB 1047 2018 revising qualifications for licensure as a massage therapist;

specifying that a massage apprentice who was licensed before a specified date may continue to perform massage therapy as authorized under his or her license;

authorizing a massage apprentice to apply for full licensure upon completion of the apprenticeship under certain conditions;

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hb1047-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/HB 1047 2018 480.046, F.S.;

prohibiting a certain massage establishments from applying for relicensure;

providing an exception;

483.824, F.S.;

revising qualification requirements for a clinical laboratory director;

amending s.

amendingPage s.6 of 80 CODING:

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hb1047-02-c2 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HB 1047 2018 amending s.

authorizing the Board of Clinical Social Work, Marriage and Family Therapy, and Mental Health CounselingCounseling, or the department under certain circumstances, to enter an order denying licensure or imposing penalties against an applicant for licensure under certain circumstances;

amending s.

1003.22, F.S.;

revising school-entry health requirements to require students to present or have a certificate of immunization on file with a public or private school;

requiring that a certificate of immunization be made on forms approved and provided by the Department of Health or be on file with the state registry of immunizations;

463.0057, 491.0046, and Page945.42, 4F.S.; of 60 CODING:

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hb1047-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/HB 1047 2018 945.42, F.S.;

conforming provisions to changes made by the act;

Paragraph (b) of subsection (1) of section 320.0848, Florida Statutes, is amended to read:

320.0848 Persons who have disabilities;

issuance of disabled parking permits;

temporary permits;

permits for certain providers of transportation services to persons who have Page 7 of 80 CODING:

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hb1047-02-c2 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HB 1047 2018 disabilities.— (1) (b)1.

The person must be currently certified as being legally blind or as having any of the following disabilities that render him or her unable to walk 200 feet without stopping to rest:

a.

Inability to walk without the use of or assistance from a brace, cane, crutch, prosthetic device, or other assistive device, or without the assistance of another person.

If the assistive device significantly restores the person's ability to walk to the extent that the person can walk without severe limitation, the person is not eligible for the exemption parking permit.

b.

The need to permanently use a wheelchair.

c.

Restriction by lung disease to the extent that the person's forced (respiratory) expiratory volume for 1 second, when measured by spirometry, is less than 1 liter, or the person's arterial oxygen is less than 60 mm/hg on room air at rest.

d.

Use of portable oxygen.

e.

Restriction by cardiac condition to the extent that the person's functional limitations are classified in severity as Class III or Class IV according to standards set by the American Heart Association.

f.

Severe limitation in the person's ability to walk due Page 8 of 80 CODING:

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hb1047-02-c2 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HB 1047 2018 to an arthritic, neurological, or orthopedic condition.

2.

The certification of disability which is required under subparagraph 1.

must be provided by a physician licensed under chapter 458, chapter 459, or chapter 460, by a podiatric physician licensed under chapter 461, by an optometrist licensed under chapter 463, by an advanced registered nurse practitioner licensed under chapter 464 under the protocol of a licensed physician as stated in this subparagraph, by a physician assistant licensed under chapter 458 or chapter 459, by a physical therapist licensed under chapter 486, or by a similarly licensed physician from another state if the application is accompanied by documentation of the physician's licensure in the other state and a form signed by the out-of-state physician verifying his or her knowledge of this state's eligibility guidelines.

Section 2.

Section 381.003, Florida Statutes, is amended to read:

381.003 Communicable disease and AIDS prevention and control.— (1) The department shall conduct a communicable disease prevention and control program as part of fulfilling its public health mission.

A communicable disease is any disease caused by transmission of a specific infectious agent, or its toxic products, from an infected person, an infected animal, or the environment to a susceptible host, either directly or Page 9 of 80 CODING:

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hb1047-02-c2 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HB 1047 2018 indirectly.

The communicable disease program must include, but need not be limited to:

(a) Programs for the prevention and control of tuberculosis in accordance with chapter 392.

(b) Programs for the prevention and control of human immunodeficiency virus infection and acquired immune deficiency syndrome in accordance with chapter 384 and this chapter.

(c) Programs for the prevention and control of sexually transmissible diseases in accordance with chapter 384.

(d) Programs for the prevention, control, and reporting of communicable diseases of public health significance as provided for in this chapter.

(e) Programs for the prevention and control of vaccine- preventable diseases, including programs to immunize school children as required by s.

1003.22(3)-(11) and the development of an automated, electronic, and centralized database and or registry of immunizations.

The department shall ensure that all children in this state are immunized against vaccine-preventable diseases.

The immunization registry shall allow the department to enhance current immunization activities for the purpose of improving the immunization of all children in this state.

1.

Except as provided in subparagraph 2., the department shall include all children born in this state in the immunization registry by using the birth records from the Office of Vital Statistics.

The department shall add other children to Page 10 of 80 CODING:

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hb1047-02-c2 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HB 1047 2018 the registry as immunization services are provided.

2.

The parent or guardian of a child may refuse to have the child included in the immunization registry by signing a form obtained from the department, or from the health care practitioner or entity that provides the immunization, which indicates that the parent or guardian does not wish to have the child included in the immunization registry.

The decision to not participate in the immunization registry must be noted in the registry.

3.

A college or university student, from 19 years of age to 23 years of age, who obtains a vaccination from a Florida college or university student health facility, may refuse to be included in the immunization registry by signing a form obtained from the department, or from the Florida college or university student health care facility, which indicates that the student does not wish to be included in the immunization registry.

The decision to not participate in the immunization registry must be noted in the registry.

4.3.

The immunization registry shall allow for immunization records to be electronically available to transferred to entities that are required by law to have such records, including, but not limited to, schools and, licensed child care facilities, and any other entity that is required by law to obtain proof of a child's immunizations.

5.4.

A Any health care practitioner licensed under chapter Page 11 of 80 CODING:

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hb1047-02-c2 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HB 1047 2018 458, chapter 459, or chapter 464 in this state who administers vaccinations or causes vaccinations to be administered to children from birth to 18 years of age is required to report vaccination data to the immunization registry, unless the parent or guardian of a child has refused to have the child included in the immunization registry by meeting the requirements of subparagraph 2.

A health care practitioner licensed under chapter 458, chapter 459, or chapter 464 in this state who administers vaccinations or causes vaccinations to be administered to college or university students from 19 years of age to 23 years of age at a Florida college or university student health care facility is required to report vaccination data to the immunization registry, unless the student has refused to be included in the immunization registry by meeting the requirements of subparagraph 3.

Vaccination data for other age ranges may be submitted to the immunization registry on a voluntary basis.

Immunization information may be updated in the immunization registry by an automated data upload from an existing automated system complies with rules adopted by the department to access the immunization registry may, through the immunization registry, directly access immunization records and update a child's immunization history or exchange immunization information with another authorized practitioner, entity, or agency involved in a child's care.

The information included in the immunization registry must include the child's name, date of Page 12 of 80 CODING:

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hb1047-02-c2 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HB 1047 2018 birth, address, and any other unique identifier necessary to correctly identify the child;

the immunization record, including the date, type of administered vaccine, and vaccine lot number;

and the presence or absence of any adverse reaction or contraindication related to the immunization.

Information received by the department for the immunization registry retains its status as confidential medical information and the department must maintain the confidentiality of that information as otherwise required by law.

A health care practitioner or other agency that obtains information from the immunization registry must maintain the confidentiality of any medical records in accordance with s.

456.057 or as otherwise required by law.

(2) The department may adopt rules pursuant to ss.

120.536(1) and 120.54 to implement this section, repeal, and amend rules related to the prevention and control of communicable diseases and the administration of the immunization registry.

Such rules may include procedures for investigating disease, timeframes for reporting disease, definitions, procedures for managing specific diseases, requirements for followup reports of known or suspected exposure to disease, and procedures for providing access to confidential information necessary for disease investigations.

For purposes of the immunization registry, the rules may include procedures for a health care practitioner to obtain authorization to use the Page 13 of 80 CODING:

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hb1047-02-c2 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HB 1047 2018 immunization registry, methods for a parent or guardian to elect not to participate in the immunization registry, and procedures for a health care practitioner licensed under chapter 458, chapter 459, or chapter 464 to access and share electronic immunization records with other entities allowed by law to have access to the records.

Section 3.

1009.65, which provide for education loan repayment or loan forgiveness and provide monetary incentives for physicians to Page 514 of 6080 CODING:

hb1047-01-c1hb1047-02-c2 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/HBCS/CS/HB 1047 2018 forgiveness and provide monetary incentives for physicians to relocate to underserved areas of the state.

To further encourage qualified physicians to relocate to and practice in underserved areas, the department, following federal eligibility requirements, shall adopt any rules necessary for the implementation of the Conrad 30 Waiver Program established under s.

214(1)214(l) of the Immigration and Nationality Act.

Section 2.4.

Paragraph (c) of subsection (4) of section 381.915, Florida Statutes, is amended to read:

381.915 Florida Consortium of National Cancer Institute Centers Program.— (4) Tier designations and corresponding weights within the Florida Consortium of National Cancer Institute Centers Program are as follows:

(c) Tier 3:

Florida-based cancer centers seeking designation as either a NCI-designated cancer center or NCI- designated comprehensive cancer center, which shall be weighted at 1.0.

1.

A cancer center shall meet the following minimum criteria to be considered eligible for Tier 3 designation in any given fiscal year:

a.

Conducting cancer-related basic scientific research and cancer-related population scientific research;

b.

Offering and providing the full range of diagnostic and treatment services on site, as determined by the Commission on Page 15 of 80 CODING:

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hb1047-02-c2 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HB 1047 2018 Cancer of the American College of Surgeons;

c.

Hosting or conducting cancer-related interventional clinical trials that are registered with the NCI's Clinical Trials Reporting Program;

d.

Offering degree-granting programs or affiliating with universities through degree-granting programs accredited or approved by a nationally recognized agency and offered through the center or through the center in conjunction with another institution accredited by the Commission on Colleges of the Southern Association of Colleges and Schools;

e.

Providing training to clinical trainees, medical trainees accredited by the Accreditation Council for Graduate Medical Education or the American Osteopathic Association, and postdoctoral fellows recently awarded a doctorate degree;

and f.

Having more than $5 million in annual direct costs associated with their total NCI peer-reviewed grant funding.

2.

The General Appropriations Act or accompanying legislation may limit the number of cancer centers which shall receive Tier 3 designations or provide additional criteria for such designation.

3.

A cancer center's participation in Tier 3 shall be limited to 6 5 years.

4.

A cancer center that qualifies as a designated Tier 3 center under the criteria provided in subparagraph 1.

by July 1, 2014, is authorized to pursue NCI designation as a cancer center Page 16 of 80 CODING:

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hb1047-02-c2 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HB 1047 2018 or a comprehensive cancer center for 6 5 years after qualification.

Section 5.

If an application is submitted electronically, the department may require supplemental materials, including an original signature Pageof 6the applicant and verification of 60credentials, CODING:to be submitted in a nonelectronic format.

An incomplete application shall expire 1 year after initial filing.

In order to further the economic development goals of the state, and notwithstanding Page 17 of 80 CODING:

hb1047-01-c1hb1047-02-c2 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/HBCS/CS/HB 1047 2018 ofany law to the applicantcontrary, andthe verificationdepartment may enter into an agreement with the county tax collector for the purpose of credentials,appointing the county tax collector as the department's agent to beaccept submittedapplications infor alicenses nonelectronicand format.applications for renewals of licenses.

An incomplete application shall expire 1 year after initial filing.

In order to further the economic development goals of the state, and notwithstanding any law to the contrary, the department may enter into an agreement with the county tax collector for the purpose of appointing the county tax collector as the department's agent to accept applications for licenses and applications for renewals of licenses.

Section 3.6.

Is a health care practitioner, other than a dentist, in Pageanother 7state, the District of 60Columbia, CODING:or a possession or territory of the United States and is the spouse of a person serving on active duty with the United States Armed Forces.

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hb1047-01-c1hb1047-02-c2 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/HBCS/CS/HB 1047 2018 anotherThe state,department theshall Districtdevelop ofan Columbia,application orform, aand possessioneach board, or territory of the Uniteddepartment Statesif andthere is theno spouseboard, ofshall awaive personthe servingapplication onfee, activelicensure dutyfee, withand theunlicensed Unitedactivity Statesfee Armedfor Forces.such applicants.

The department shall develop an application form, and each board, or the department if there is no board, shall waive the application fee, licensure fee, and unlicensed activity fee for such applicants.

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Is a military health care practitioner in a profession for which licensure in a state or jurisdiction is not required to practice in the United States Armed Forces, if he or she submits to the department evidence of military training or Page 19 of 80 CODING:

hb1047-01-c1hb1047-02-c2 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/HBCS/CS/HB 1047 2018 b.experience substantially equivalent to the requirements for licensure in this state in that profession and evidence that he or she has obtained a passing score on the appropriate examination of a national or regional standards organization if required for licensure in this state;

Is a military health care practitioner in a profession for which licensure in a state or jurisdiction is not required to practice in the United States Armed Forces, if he or she submits to the department evidence of military training or experience substantially equivalent to the requirements for licensure in this state in that profession and evidence that he or she has obtained a passing score on the appropriate examination of a national or regional standards organization if required for licensure in this state;

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hb1047-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/HB 1047 2018 5.

Submits a set of fingerprints for a background screeningPage pursuant20 toof s.80 CODING:

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hb1047-02-c2 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HB 1047 2018 screening pursuant to s.

Section 4.7.

Section 460.4166,458.3113, Florida Statutes, is repealed.created to read:

Section458.3113 5.Conditions of licensure, reimbursement, or admitting privileges.— (1) For purposes of this section, the term:

Section(a) 463.006,"Maintenance Floridaof Statutes,certification" ismeans amendeda periodic testing regimen, proprietary self-assessment requirement, peer evaluation, or other requirement imposed by the American Board of Medical Specialties Program for Maintenance of Certification and its member boards, or by any recognizing agency approved by the board pursuant to read:rule for any board-certified specialty or subspecialty.

463.006(b) Licensure"Recertification" andmeans certification by examination.— (1) Any person desiring to be a licensedsubsequent practitionerrecognition pursuantor tocertification thisof chaptereducational shallor applyscholarly toachievement thebeyond departmentPage to21 takeof the80 licensureCODING: and certification examinations.

The department shall license examine each applicant who the board determines has:

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hb1047-01-c1hb1047-02-c2 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/HBCS/CS/HB 1047 2018 (a)initial Completedboard thecertification applicationimposed forms as required by the board,American remittedBoard anof applicationMedical feeSpecialties Program for certificationMaintenance notof toCertification exceedand $250,its remittedmember anboards, examinationor feeby forany certificationrecognizing notagency toapproved exceedby $250,the andboard remittedpursuant ato anrule examination fee for licensureany notboard-certified tospecialty exceedor $325,subspecialty. all as set by the board.

(b)(2) SubmittedThe prooflegislature satisfactoryfinds that a robust, vibrant, flexible, and fluid physician workforce is integral to the departmentdelivery thatof shequality orand he:accessible health care.

The Legislature further finds that any artificial interference with the size and mobility of the physician workforce acts as an impediment to the free and unimpeded access to care and the facilities that help provide care.

(3)(a) Notwithstanding a physician's maintenance of certification, an osteopathic physician's continuing certification or board recertification status, or other provision of law, any physician licensed under chapter 458 or chapter 459, is eligible to participate in any health care facility or licensure, except that a health care facility licensed under chapter 395 may differentiate between physicians of a specified medical specialty based on a physician's maintenance of certification if:

IsThe athealth leastcare 18facility's yearsdesignation under law or certification or accreditation by a national certifying or accreditation organization is contingent on the facility requiring maintenance of age.certification of physicians for a Page 22 of 80 CODING:

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hb1047-02-c2 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HB 1047 2018 specified medical specialty seeking staff privileges or credentialing at the facility and the differentiation is limited to those physicians with the specified medical specialty whose maintenance of certification is required for the entity's designation, certification, or accreditation;

or 2.

The voting physician members of the health care facility's organized medical staff authorize the differentiation for a specialized medical specialty provided such authorization is made only by the voting physician members of the facility and not by the facility's governing body, administration, or any other person.

(b) The board, in consultation with the Agency for Health Care Administration, shall have authority to review and overrule a decision to require maintenance of supervision by a health care facility licensed under chapter 395.

(4) This section may not be construed to prohibit the board from requiring continuing medical education.

Section 8.

Section 458.3312, Florida Statutes, is amended to read:

458.3312 Specialties.—A physician licensed under this chapter may not hold himself or herself out as a board-certified specialist unless the physician has received formal recognition as a specialist from a specialty board of the American Board of Medical Specialties or other recognizing agency that has been approved by the board.

However, a physician may indicate the Page 23 of 80 CODING:

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hb1047-02-c2 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HB 1047 2018 services offered and may state that his or her practice is limited to one or more types of services when this accurately reflects the scope of practice of the physician.

A physician may not hold himself or herself out as a board-certified specialist in dermatology unless the recognizing agency, whether authorized in statute or by rule, is triennially reviewed and reauthorized by the Board of Medicine.

Section 9.

Paragraph (d) of subsection (7) of section 458.347, Florida Statutes, is amended to read:

458.347 Physician assistants.— (7) PHYSICIAN ASSISTANT LICENSURE.— (d) Upon employment as a physician assistant, a licensed physician assistant must notify the department in writing within 30 days after such employment and provide or after any subsequent changes in the supervising physician.

The notification must include the full name, Florida medical license number, specialty, and address of a supervising physician or designated the supervising physician.

The licensed physician assistant must report any subsequent change in the supervising physician or designated supervising physician to the department within 30 days after the change.

Assignment of a designated physician does not preclude a physician assistant from practicing under the supervision of a physician other than the designated supervising physician if:

1.

The designated supervising physician is designated as Page 24 of 80 CODING:

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hb1047-02-c2 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HB 1047 2018 the primary contact by the facility or physician practice group that employs the physician assistant if the physician assistant is subject to supervision by more than one supervising physician.

HasThe graduateddesignated fromsupervising anphysician accreditedmaintains schoola orcurrent collegelist of optometryall approved bysupervising rulephysicians at the facility or physician group practice that includes the name of each supervising physician and the board.physician's area of practice, and provides such list to the department or board upon written request.

3.Section 10.

IsParagraph (l) of goodsubsection moral(1) character.of section 459.0055, Florida Statutes, is amended to read:

3.4.459.0055 General licensure requirements.— (1) Except as otherwise provided herein, any person desiring to be licensed or certified as an osteopathic physician pursuant to this chapter shall:

Has(l) Demonstrate that she or he has successfully completed atan leastinternship 110or hoursresidency a resident internship of transcript-qualitynot courseworkless andthan clinical12 trainingmonths in generala andprogram ocularaccredited pharmacologyhospital asapproved determinedfor this purpose by the board,Board atof anTrustees institutionof that:the American Osteopathic Association or the Accreditation Council for Graduate Medical Education any other internship program approved by the board upon a showing of good cause by the applicant.

a.This requirement may be waived for an applicant who matriculated in a college of osteopathic medicine during or before 1948;

Has facilities for both didactic and clinicalPage instructions25 inof pharmacology;80 CODING:

and b.

Is accredited by a regional or professional accrediting organization that is recognized and approved by the Commission on Recognition of Postsecondary Accreditation or the United States Department of Education.

4.5.

Has completed at least 1 year of supervised experience in differential diagnosis of eye disease or disorders as part of the optometric training or in a clinical setting as part of the optometric experience.

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hb1047-01-c1hb1047-02-c2 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/HBCS/CS/HB 1047 2018 5.Section 11.

HasSection obtained459.0056, aFlorida passingStatutes, score,is ascreated establishedto byread: rule of the board, on the licensure examination of the National Board of Examiners in Optometry or a similar nationally recognized examination approved by the board.

(2)459.0056 TheConditions examination shall consist of thelicensure, appropriatereimbursement, subjects,or includingadmitting applicableprivileges.— state(1) lawsFor andpurposes rulesof andthis generalsection, and ocular pharmacology with emphasis on the useterm: and side effects of ocular pharmaceutical agents.

The(a) board"Osteopathic maycontinuing bycertification" rulemeans substitute a nationalperiodic examinationtesting asregimen, partproprietary self-assessment requirement, peer evaluation, or allother requirement imposed by the osteopathic continuing certification program of the examinationBureau of Osteopathic Specialists of the American Osteopathic Association and mayits specialty boards, or by ruleany offerrecognizing aagency practicalapproved examinationby inthe additionboard pursuant to therule writtenfor examination.any board- certified specialty or subspecialty.

(2)(3)(b) Each"Recertification" applicantmeans whoa successfullysubsequent passesrecognition theor examinationcertification andof otherwiseeducational meetsor scholarly achievement beyond initial board certification imposed by the requirementsBureau of thisOsteopathic chapterSpecialists isof entitledthe toAmerican beOsteopathic licensedAssociation asand aits practitionerspecialty andboards, toor beby certifiedany torecognizing administeragency andapproved prescribeby ocularthe pharmaceuticalboard agentspursuant into therule diagnosisfor andany treatmentboard-certified ofspecialty ocularor conditions.subspecialty.

Section(2) 6.The legislature finds that a robust, vibrant, flexible, and fluid physician workforce is integral to the delivery of quality and accessible health care.

SectionThe 463.0061,Legislature Floridafurther Statutes,finds isthat createdany artificial interference with the size and mobility of the physician workforce acts as an impediment to read:the Page 26 of 80 CODING:

463.0061 Licensure by endorsement;

requirements;

fees.— (1) Any person desiring to be a licensed practitioner pursuant to this chapter shall apply to the department.

The department shall issue a license by endorsement to any applicant who, upon applying to the department on forms furnished by the department and remitting a nonrefundable application fee set by the board not to exceed $250 and a licensure fee not to exceed Page 12 of 60 CODING:

hb1047-01-c1hb1047-02-c2 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/HBCS/CS/HB 1047 2018 $325,free and unimpeded access to care and the boardfacilities certifies:that help provide care.

(a)(3)(a) HasNotwithstanding graduateda fromphysician's maintenance of certification, an accreditedosteopathic schoolphysician's continuing certification or collegeboard recertification status, or other provision of optometrylaw, accreditedany byphysician alicensed regionalunder chapter 458 or professionalchapter accrediting459, organizationis eligible to participate in any health care facility or licensure, except that isa recognizedhealth andcare approvedfacility bylicensed theunder Commissionchapter on395 Recognitionmay differentiate between physicians of Postsecondarya Accreditationspecified ormedical thespecialty Unitedbased Stateson Departmenta physician's maintenance of Education.certification if:

(b)1. Has obtained an overall passing score, as established by rule of the board, on the licensure examination of the National Board of Examiners in Optometry or a similar nationally recognized examination approved by the board.

(c)The Hashealth submittedcare evidencefacility's ofdesignation anunder active,law licensedor practicecertification ofor optometryaccreditation inby anothera jurisdiction,national forcertifying ator leastaccreditation 5organization ofis thecontingent immediatelyon precedingthe 7facility years,requiring ormaintenance evidence of successfulcertification completion of physicians for a board-approvedspecified clinicalmedical competencyspecialty examinationseeking withinstaff privileges or credentialing at the yearfacility precedingand the filingdifferentiation is limited to those physicians with the specified medical specialty whose maintenance of ancertification applicationis required for licensure.the entity's designation, certification, or accreditation;

For purposes of this paragraph, "active licensed practice of optometry" means that practice of optometry by optometrists, including those employed by any federal or state2. governmental entity in community or public health.

(d)The Hasvoting successfullyphysician completedmembers of the clinicalhealth skillscare portionfacility's oforganized medical staff authorize the examinationdifferentiation developedfor a specialized medical specialty provided such authorization is made only by the Nationalvoting Boardphysician members of Examinersthe infacility Optometry.and not by the facility's governing body, administration, or any Page 27 of 80 CODING:

In addition to an overall passing score on the clinical skills portion, an applicant must obtain a score of 75 percent or better on each of the biomicroscopy, binocular indirect ophthalmoscopy, and dilated biomicroscopy and Page 13 of 60 CODING:

hb1047-01-c1hb1047-02-c2 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/HBCS/CS/HB 1047 2018 noncontactother fundusperson. lens evaluation skills individually.

(e)(b) HasThe successfullyboard, completedin aconsultation writtenwith examinationthe onAgency applicablefor generalHealth lawsCare Administration, shall have authority to review and rulesoverrule governinga thedecision practiceto require maintenance of optometry.supervision by a health care facility licensed under chapter 395.

(f)(4) HasThis obtainedsection amay passingnot scorebe onconstrued eitherto theprohibit Treatment and Management of Ocular Disease examination in the Patientboard Assessmentfrom andrequiring Managementcontinuing portionmedical ofeducation. the examination developed by the National Board of Examiners in Optometry or the stand alone Treatment and Management of Ocular Disease examination developed by the National Board of Examiners in Optometry.

(2)Section The12. applicant shall submit evidence of completing a total of at least 30 hours of board-approved continuing education for the 2 calendar years immediately preceding application.

(3)Paragraph The(d) departmentof shallsubsection not(7) issue a license by endorsement to any applicant who is under investigation in any jurisdiction for an act or offense which would constitute a violation of thissection chapter459.022, untilFlorida suchStatutes, time as the investigation is complete,amended atto whichread: time the provisions of s.

463.016459.022 shallPhysician apply.assistants.— (7) PHYSICIAN ASSISTANT LICENSURE.— (d) Upon employment as a physician assistant, a licensed physician assistant must notify the department in writing within 30 days after such employment and provide or after any subsequent changes in the supervising physician.

Furthermore,The thenotification departmentmust mayinclude notthe issuefull anname, unrestrictedFlorida medical license tonumber, anyspecialty, individualand whoaddress hasof committeda anysupervising actphysician or offensedesignated in any jurisdiction constituting the basissupervising forphysician. disciplining an optometrist pursuant to s.

463.016.A licensed physician assistant must report any subsequent change in his or her supervising physician or designated supervising physician to the department within 30 days after the change.

IfAssignment theof boarda findsdesignated thatphysician andoes individualnot haspreclude committeda anphysician actassistant orfrom offensepracticing constitutingunder the basissupervision forof disciplininga anphysician optometristother pursuantthan tothe s.designated supervising physician if:

463.016,1. Page 14 of 60 CODING:

The designated supervising physician is designated as Page 28 of 80 CODING:

hb1047-01-c1hb1047-02-c2 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/HBCS/CS/HB 1047 2018 the boardprimary maycontact enterby anthe orderfacility imposingor onephysician orpractice moregroup ofthat employs the termsphysician setassistant forthif inthe subsectionphysician (4).assistant is subject to supervision by more than one supervising physician.

(4)2. When the board determines that an applicant for licensure by endorsement has failed to satisfy each of the appropriate requirements in this section, it may enter an order requiring one or more of the following:

(a)The Refusaldesignated tosupervising certifyphysician tomaintains a current list of all approved supervising physicians at the departmentfacility anor applicationphysician forgroup licensurepractice that includes the name of each supervising physician and the physician's area of practice, and provides such list to the department or certification;board upon written request.

(b)Section Certify13. to the department an application for licensure or certification with restrictions on the scope of practice of the licensee;

orSubsection (c)(1) Certifyof tosection the460.408, departmentFlorida anStatutes, applicationis foramended licensure or certification with a probationary period subject to conditionsread: specified by the board, including, but not limited to, requiring the optometrist to submit to treatment, attend continuing education courses, submit to reexamination, or work under the supervision of another licensed optometrist.

Section460.408 7.Continuing chiropractic education.— (1) The board shall require licensees to periodically demonstrate their professional competence as a condition of renewal of a license by completing up to 40 contact classroom hours of continuing education.

SectionFor 464.006,purposes Floridaof Statutes,this issubsection, amendedthe toterm read:"contact classroom hour" means a presentation in which the persons presenting and the persons attending the course are present on site.

464.006Up Rulemakingto authority.—The10 boardgeneral credit continuing education hours may hasbe authoritycompleted toonline adoptin rulesplace pursuantof tocontact ss.classroom hours, as determined by board rule.

120.536(1)Online andcontinuing 120.54education tocourses implementmust be competency-based and must use the provisionsShareable ofContent thisObjective partReference conferringModel dutiesstandard uponor itmore andstringent establishstandards, standardsas ofdetermined care.by the board.

SectionPage 8.29 of 80 CODING:

Section 464.202, Florida Statutes, is amended to read:

Page 15 of 60 CODING:

hb1047-01-c1hb1047-02-c2 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/HBCS/CS/HB 1047 2018 464.202(a) DutiesContinuing andeducation powerscourses ofsponsored theby board.—Thechiropractic boardcolleges shallwhose maintain,graduates orare contracteligible withfor orexamination approveunder anotherany entityprovision toof maintain,this achapter statemay registrybe approved upon review by the board if all other requirements of certifiedboard nursingrules assistants.setting forth criteria for course approval are met.

(b) The board shall approve those courses that build upon the basic courses required for the practice of chiropractic medicine, and the board may also approve courses in adjunctive modalities.

Courses that consist of instruction in the use, application, prescription, recommendation, or administration of a specific company's brand of products or services are not eligible for approval.

Section 14.

Section 460.4166, Florida Statutes, is repealed.

Section 15.

Section 464.202, Florida Statutes, is amended to read:

464.202 Duties and powers of the board.—The board shall maintain, or contract with or approve another entity to maintain, a state registry of certified nursing assistants.

and any disciplinary actionPage taken30 againstof the80 certifiedCODING: nursing assistant.

Words stricken are deletions;

words underlined are additions.

hb1047-02-c2 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HB 1047 2018 action taken against the certified nursing assistant.

The board shall Pagerequire 16the contract provider to provide the preliminary results of 60the CODING:certified nursing examination on the date the test is administered.

Words stricken are deletions;

words underlined are additions.

hb1047-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/HB 1047 2018 require the contract provider to provide the preliminary results of the certified nursing examination on the date the test is administered.

Section 9.16.

464.203Page Certified31 nursingof assistants;80 CODING:

Words stricken are deletions;

words underlined are additions.

hb1047-02-c2 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HB 1047 2018 464.203 Certified nursing assistants;

(c) Is currently certified in another state or territory,territory of the United States, and the District of Columbia;

is listed on that state's Pagecertified 17nursing ofassistant 60registry; CODING:

Words stricken are deletions;

words underlined are additions.

hb1047-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/HB 1047 2018 certified nursing assistant registry;

Section 10.17.

disciplinary actions.— (1) The following acts constitute grounds for which the board may impose disciplinary sanctions as specified in subsectionPage (2):32 of 80 CODING:

Words stricken are deletions;

words underlined are additions.

hb1047-02-c2 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HB 1047 2018 subsection (2):

Section 11.18.

Section 12.19.

Page465.0193 18Nuclear ofpharmacy 60permits.—Any CODING:person desiring a permit to operate a nuclear pharmacy shall apply to the department.

Words stricken are deletions;

words underlined are additions.

hb1047-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/HB 1047 2018 465.0193 Nuclear pharmacy permits.—Any person desiring a permit to operate a nuclear pharmacy shall apply to the department.

A nuclear pharmacy must pass an onsite inspection by the department as a prerequisite to thePage issuance33 of an80 initialCODING: permit or a permit for a change of location.

Words stricken are deletions;

words underlined are additions.

hb1047-02-c2 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HB 1047 2018 the issuance of an initial permit or a permit for a change of location.

Section 13.20.

Page(2) 19If the board certifies that the application complies with applicable laws and rules of 60the CODING:board governing pharmacies, the department shall issue the permit.

Words stricken are deletions;

words underlined are additions.

hb1047-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/HB 1047 2018 (2) If the board certifies that the application complies with applicable laws and rules of the board governing pharmacies, the department shall issue the permit.

The board may adopt by rule, standards forPage the34 conducting of an80 onsiteCODING: inspection for issuance of a sterile compounding permit.

Words stricken are deletions;

words underlined are additions.

hb1047-02-c2 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HB 1047 2018 for the conducting of an onsite inspection for issuance of a sterile compounding permit.

In adopting such rules, the board shall give due consideration to the standards and requirements provided in chapter 797 of the United States Pharmacopeia, or other professionally accepted standards deemed authoritative by Pagethe 20board. of 60 CODING:

Words stricken are deletions;

words underlined are additions.

hb1047-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/HB 1047 2018 the board.

SectionPage 14.35 of 80 CODING:

Words stricken are deletions;

words underlined are additions.

hb1047-02-c2 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HB 1047 2018 Section 21.

The licensed pharmacist shall be responsible for maintaining all drug records and for providing for the security of the area in the facility Pagein 21which the compounding, storing, and dispensing of 60medicinal CODING:drugs occurs.

Words stricken are deletions;

words underlined are additions.

hb1047-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/HB 1047 2018 in which the compounding, storing, and dispensing of medicinal drugs occurs.

Section 15.22.

Subsection (2) of section 465.0197, Florida Statutes,Page is36 amendedof to80 read:CODING:

Words stricken are deletions;

words underlined are additions.

hb1047-02-c2 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HB 1047 2018 Statutes, is amended to read:

Section 16.23.

SubsectionSection (4)465.0235, of section 466.006, Florida Statutes, is amended to read:

466.006465.0235 ExaminationAutomated ofpharmacy dentists.—systems (4)used Notwithstandingby anylong-term othercare provisionfacilities, ofhospices, lawor instate chaptercorrectional 456institutions, pertainingor tofor theoutpatient clinicaldispensing.— dental(1) licensureA examinationpharmacy ormay nationalprovide examinations,pharmacy services to bea long- term care facility or hospice licensed asunder chapter 400 or chapter 429 or a dentiststate incorrectional thisinstitution state,operated under chapter 944 through the use of an applicantautomated mustpharmacy successfullysystem completethat need not be located at the following:same location as the pharmacy.

(a)(2) A writtencommunity examinationpharmacy, onas thedefined lawsin ands. rules of the state regulating the practice of dentistry;

Page465.003, 22may provide pharmacy services for outpatient dispensing through the use of 60an CODING:automated pharmacy system in a different location than the community pharmacy, provided that:

(a) The automated pharmacy system is under the supervision and control of the Florida-licensed community pharmacy.

(b) The community pharmacy providing services through the Page 37 of 80 CODING:

hb1047-01-c1hb1047-02-c2 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/HBCS/CS/HB 1047 2018 (b)1.automated pharmacy system notifies the Board of Pharmacy of the location of the automated pharmacy system and any location changes.

(c) The automated pharmacy system is under the supervision of a Florida-licensed pharmacist who must be available and accessible for patient counseling prior to the dispensing of any medicinal drug.

(d) The automated pharmacy system does not contain or dispense any controlled substances listed in Schedule II, Schedule III, Schedule IV, or Schedule V of s.

893.03 or 21 U.S.C.

s.

812.

(e) The pharmacy maintains a record of the medicinal drugs dispensed, including the identity of the Florida-licensed pharmacist responsible for verifying the accuracy of the dosage and directions and providing patient counseling.

(f) The automated pharmacy system ensures the confidentiality of personal health information.

(3)(2) Medicinal drugs stored in bulk or unit of use in an automated pharmacy system servicing a long-term care facility, hospice, or correctional institution, or outpatient dispensing, are part of the inventory of the pharmacy providing pharmacy services to that facility, hospice, or institution, or outpatient dispensing, and drugs delivered by the automated pharmacy system are considered to have been dispensed by that pharmacy.

Page 38 of 80 CODING:

Words stricken are deletions;

words underlined are additions.

hb1047-02-c2 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HB 1047 2018 (4)(3) The operation of an automated pharmacy system must be under the supervision of a Florida-licensed pharmacist.

To qualify as a supervisor for an automated pharmacy system, the pharmacist need not be physically present at the site of the automated pharmacy system and may supervise the system electronically.

The Florida-licensed pharmacist shall be required to develop and implement policies and procedures designed to verify that the medicinal drugs delivered by the automated dispensing system are accurate and valid and that the machine is properly restocked.

(5)(4) The Legislature does not intend this section to limit the current practice of pharmacy in this state.

This section is intended to allow automated pharmacy systems to enhance the ability of a pharmacist to provide pharmacy services in locations that do not employ a full-time pharmacist.

This section does not limit or replace the use of a consultant pharmacist.

(6)(5) The board shall adopt rules governing the use automated pharmacy systems of an automated pharmacy system by January 1, 2005, which must include specify:

(a) Recordkeeping requirements;

(b) Security requirements;

and (c) Labeling requirements that permit the use of unit-dose medications if the facility, hospice, or institution maintains medication-administration records that include directions for Page 39 of 80 CODING:

Words stricken are deletions;

words underlined are additions.

hb1047-02-c2 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HB 1047 2018 use of the medication and the automated pharmacy system identifies:

1.

The dispensing pharmacy;

2.

The prescription number;

3.

The name of the patient;

and 4.

The name of the prescribing practitioner.

Section 24.

Paragraph (b) of subsection (3) and subsection (4) of section 466.006, Florida Statutes, are amended to read:

466.006 Examination of dentists.— (3) If an applicant is a graduate of a dental college or school not accredited in accordance with paragraph (2)(b) or of a dental college or school not approved by the board, the applicant is not entitled to take the examinations required in this section to practice dentistry until she or he satisfies one of the following:

(b) Submits proof of having successfully completed at least 2 consecutive academic years at a full-time supplemental general dentistry program accredited by the American Dental Association Commission on Dental Accreditation.

This program must provide didactic and clinical education at the level of a D.D.S.

or D.M.D.

program accredited by the American Dental Association Commission on Dental Accreditation.

For purposes of this paragraph, a supplemental general dentistry program does not include an advanced education program in a dental specialty.

(4) Notwithstanding any other provision of law in chapter Page 40 of 80 CODING:

Words stricken are deletions;

words underlined are additions.

hb1047-02-c2 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HB 1047 2018 456 pertaining to the clinical dental licensure examination or national examinations, to be licensed as a dentist in this state, an applicant must successfully complete the following:

(a) A written examination on the laws and rules of the state regulating the practice of dentistry;

(b)1.

As an alternative to the requirements of subparagraph 1., an applicant may submit scores from an American Dental Licensing Examination previously administered in a jurisdiction other than this state after October 1, 2011, and such examinationPage results41 shall be recognized as valid for the purpose of licensure80 inCODING: this state.

A passing score on the American Dental Licensing Examination administered out-of-state shall be the same as the passing score for the American Dental Licensing Examination administered in this state and graded by dentists Page 23 of 60 CODING:

hb1047-01-c1hb1047-02-c2 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/HBCS/CS/HB 1047 2018 whoexamination areresults licensedshall be recognized as valid for the purpose of licensure in this state.

A passing score on the American Dental Licensing Examination administered out-of-state shall be the same as the passing score for the American Dental Licensing Examination administered in this state and graded by dentists who are licensed in this state.

The applicant graduated from a dental school accredited by the American Dental Association Commission on Dental Accreditation or its successor entity, if any, or any other dentalPage accrediting42 organization recognized by the United States Department of Education.80 CODING:

Provided, however, if the applicant did not graduate from such a dental school, the applicant may submit proof of having successfully completed a full-time supplemental general dentistry program accredited by the American Dental Page 24 of 60 CODING:

hb1047-01-c1hb1047-02-c2 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/HBCS/CS/HB 1047 2018 Associationdental Commissionaccrediting onorganization Dentalrecognized Accreditationby ofthe atUnited leastStates 2Department consecutiveof academicEducation. years at such accredited sponsoring institution.

Provided, however, if the applicant did not graduate from such a dental school, the applicant may submit proof of having successfully completed a full-time supplemental general dentistry program accredited by the American Dental Association Commission on Dental Accreditation of at least 2 consecutive academic years at such accredited sponsoring institution.

program accredited by the American Dental Association Commission on Dental Accreditation;Accreditation.

For purposes of this paragraph, a supplemental general dentistry program does not include an advanced education program in a dental specialty;

This sub- subparagraph does not apply if the applicant successfully appealed to have his or her name removed from the data banks of thesePage agencies;43 of 80 CODING:

e.(I) In the 5 years immediately preceding the date of application for licensure in this state, the applicant must submit proof of having been consecutively engaged in the full- time practice of dentistry in another state or territory of the United States, the District of Columbia, or the Commonwealth of Puerto Rico, or, if the applicant has been licensed in another Page 25 of 60 CODING:

hb1047-01-c1hb1047-02-c2 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/HBCS/CS/HB 1047 2018 statethese oragencies; territory of the United States, the District of Columbia, or the Commonwealth of Puerto Rico for less than 5 years, the applicant must submit proof of having been engaged in the full-time practice of dentistry since the date of his or her initial licensure.

e.(I) In the 5 years immediately preceding the date of application for licensure in this state, the applicant must submit proof of having been consecutively engaged in the full- time practice of dentistry in another state or territory of the United States, the District of Columbia, or the Commonwealth of Puerto Rico, or, if the applicant has been licensed in another state or territory of the United States, the District of Columbia, or the Commonwealth of Puerto Rico for less than 5 years, the applicant must submit proof of having been engaged in the full-time practice of dentistry since the date of his or her initial licensure.

(C) Full-time practice as a student at a postgraduate dental education program approved by the board or accredited by thePage American44 Dentalof Association80 CommissionCODING: on Dental Accreditation.