Bill Amendment: FL S0012 | 2016 | Regular Session
NOTE: For additional amemendments please see the Bill Drafting List
Bill Title: Mental Health and Substance Abuse
Status: 2016-04-15 - Chapter No. 2016-241, companion bill(s) passed, see CS/HB 373 (Ch. 2016-80), CS/CS/CS/HB 439 (Ch. 2016-127), HB 5101 (Ch. 2016-65) [S0012 Detail]
Download: Florida-2016-S0012-Senate_Floor_S_Amend_to_H_Amend_171349_589782.html
Bill Title: Mental Health and Substance Abuse
Status: 2016-04-15 - Chapter No. 2016-241, companion bill(s) passed, see CS/HB 373 (Ch. 2016-80), CS/CS/CS/HB 439 (Ch. 2016-127), HB 5101 (Ch. 2016-65) [S0012 Detail]
Download: Florida-2016-S0012-Senate_Floor_S_Amend_to_H_Amend_171349_589782.html
Florida Senate - 2016 SENATOR AMENDMENT Bill No. CS/SB 12, 2nd Eng. Ì589782UÎ589782 LEGISLATIVE ACTION Senate . House . . . Floor: WD . 03/11/2016 11:13 AM . ————————————————————————————————————————————————————————————————— ————————————————————————————————————————————————————————————————— Senator Grimsley moved the following: 1 Senate Amendment to House Amendment (171349) (with title 2 amendment) 3 4 Delete line 4950 5 and insert: 6 Section 101. Subsection (7) of section 110.12315, Florida 7 Statutes, is amended to read: 8 110.12315 Prescription drug program.—The state employees’ 9 prescription drug program is established. This program shall be 10 administered by the Department of Management Services, according 11 to the terms and conditions of the plan as established by the 12 relevant provisions of the annual General Appropriations Act and 13 implementing legislation, subject to the following conditions: 14 (7) The department shall establish the reimbursement 15 schedule for prescription pharmaceuticals dispensed under the 16 program. Reimbursement rates for a prescription pharmaceutical 17 must be based on the cost of the generic equivalent drug if a 18 generic equivalent exists, unless the physician, advanced 19 registered nurse practitioner, or physician assistant 20 prescribing the pharmaceutical clearly states on the 21 prescription that the brand name drug is medically necessary or 22 that the drug product is included on the formulary of drug 23 products that may not be interchanged as provided in chapter 24 465, in which case reimbursement must be based on the cost of 25 the brand name drug as specified in the reimbursement schedule 26 adopted by the department. 27 Section 102. Paragraph (c) of subsection (1) of section 28 310.071, Florida Statutes, is amended, and subsection (3) of 29 that section is republished, to read: 30 310.071 Deputy pilot certification.— 31 (1) In addition to meeting other requirements specified in 32 this chapter, each applicant for certification as a deputy pilot 33 must: 34 (c) Be in good physical and mental health, as evidenced by 35 documentary proof of having satisfactorily passed a complete 36 physical examination administered by a licensed physician within 37 the preceding 6 months. The board shall adopt rules to establish 38 requirements for passing the physical examination, which rules 39 shall establish minimum standards for the physical or mental 40 capabilities necessary to carry out the professional duties of a 41 certificated deputy pilot. Such standards shall include zero 42 tolerance for any controlled substance regulated under chapter 43 893 unless that individual is under the care of a physician, an 44 advanced registered nurse practitioner, or a physician assistant 45 and that controlled substance was prescribed by that physician, 46 advanced registered nurse practitioner, or physician assistant. 47 To maintain eligibility as a certificated deputy pilot, each 48 certificated deputy pilot must annually provide documentary 49 proof of having satisfactorily passed a complete physical 50 examination administered by a licensed physician. The physician 51 must know the minimum standards and certify that the 52 certificateholder satisfactorily meets the standards. The 53 standards for certificateholders shall include a drug test. 54 (3) The initial certificate issued to a deputy pilot shall 55 be valid for a period of 12 months, and at the end of this 56 period, the certificate shall automatically expire and shall not 57 be renewed. During this period, the board shall thoroughly 58 evaluate the deputy pilot’s performance for suitability to 59 continue training and shall make appropriate recommendations to 60 the department. Upon receipt of a favorable recommendation by 61 the board, the department shall issue a certificate to the 62 deputy pilot, which shall be valid for a period of 2 years. The 63 certificate may be renewed only two times, except in the case of 64 a fully licensed pilot who is cross-licensed as a deputy pilot 65 in another port, and provided the deputy pilot meets the 66 requirements specified for pilots in paragraph (1)(c). 67 Section 103. Subsection (3) of section 310.073, Florida 68 Statutes, is amended to read: 69 310.073 State pilot licensing.—In addition to meeting other 70 requirements specified in this chapter, each applicant for 71 license as a state pilot must: 72 (3) Be in good physical and mental health, as evidenced by 73 documentary proof of having satisfactorily passed a complete 74 physical examination administered by a licensed physician within 75 the preceding 6 months. The board shall adopt rules to establish 76 requirements for passing the physical examination, which rules 77 shall establish minimum standards for the physical or mental 78 capabilities necessary to carry out the professional duties of a 79 licensed state pilot. Such standards shall include zero 80 tolerance for any controlled substance regulated under chapter 81 893 unless that individual is under the care of a physician, an 82 advanced registered nurse practitioner, or a physician assistant 83 and that controlled substance was prescribed by that physician, 84 advanced registered nurse practitioner, or physician assistant. 85 To maintain eligibility as a licensed state pilot, each licensed 86 state pilot must annually provide documentary proof of having 87 satisfactorily passed a complete physical examination 88 administered by a licensed physician. The physician must know 89 the minimum standards and certify that the licensee 90 satisfactorily meets the standards. The standards for licensees 91 shall include a drug test. 92 Section 104. Paragraph (b) of subsection (3) of section 93 310.081, Florida Statutes, is amended to read: 94 310.081 Department to examine and license state pilots and 95 certificate deputy pilots; vacancies.— 96 (3) Pilots shall hold their licenses or certificates 97 pursuant to the requirements of this chapter so long as they: 98 (b) Are in good physical and mental health as evidenced by 99 documentary proof of having satisfactorily passed a physical 100 examination administered by a licensed physician or physician 101 assistant within each calendar year. The board shall adopt rules 102 to establish requirements for passing the physical examination, 103 which rules shall establish minimum standards for the physical 104 or mental capabilities necessary to carry out the professional 105 duties of a licensed state pilot or a certificated deputy pilot. 106 Such standards shall include zero tolerance for any controlled 107 substance regulated under chapter 893 unless that individual is 108 under the care of a physician, an advanced registered nurse 109 practitioner, or a physician assistant and that controlled 110 substance was prescribed by that physician, advanced registered 111 nurse practitioner, or physician assistant. To maintain 112 eligibility as a certificated deputy pilot or licensed state 113 pilot, each certificated deputy pilot or licensed state pilot 114 must annually provide documentary proof of having satisfactorily 115 passed a complete physical examination administered by a 116 licensed physician. The physician must know the minimum 117 standards and certify that the certificateholder or licensee 118 satisfactorily meets the standards. The standards for 119 certificateholders and for licensees shall include a drug test. 120 121 Upon resignation or in the case of disability permanently 122 affecting a pilot’s ability to serve, the state license or 123 certificate issued under this chapter shall be revoked by the 124 department. 125 Section 105. Subsection (7) of section 456.072, Florida 126 Statutes, is amended to read: 127 456.072 Grounds for discipline; penalties; enforcement.— 128 (7) Notwithstanding subsection (2), upon a finding that a 129 physician has prescribed or dispensed a controlled substance, or 130 caused a controlled substance to be prescribed or dispensed, in 131 a manner that violates the standard of practice set forth in s. 132 458.331(1)(q) or (t), s. 459.015(1)(t) or (x), s. 461.013(1)(o) 133 or (s), or s. 466.028(1)(p) or (x), or that an advanced 134 registered nurse practitioner has prescribed or dispensed a 135 controlled substance, or caused a controlled substance to be 136 prescribed or dispensed, in a manner that violates the standard 137 of practice set forth in s. 464.018(1)(n) or (p)6., the 138 physician or advanced registered nurse practitioner shall be 139 suspended for a period of not less than 6 months and pay a fine 140 of not less than $10,000 per count. Repeated violations shall 141 result in increased penalties. 142 Section 106. Section 456.44, Florida Statutes, is amended 143 to read: 144 456.44 Controlled substance prescribing.— 145 (1) DEFINITIONS.—As used in this section, the term: 146 (a) “Addiction medicine specialist” means a board-certified 147 psychiatrist with a subspecialty certification in addiction 148 medicine or who is eligible for such subspecialty certification 149 in addiction medicine, an addiction medicine physician certified 150 or eligible for certification by the American Society of 151 Addiction Medicine, or an osteopathic physician who holds a 152 certificate of added qualification in Addiction Medicine through 153 the American Osteopathic Association. 154 (b) “Adverse incident” means any incident set forth in s. 155 458.351(4)(a)-(e) or s. 459.026(4)(a)-(e). 156 (c) “Board-certified pain management physician” means a 157 physician who possesses board certification in pain medicine by 158 the American Board of Pain Medicine, board certification by the 159 American Board of Interventional Pain Physicians, or board 160 certification or subcertification in pain management or pain 161 medicine by a specialty board recognized by the American 162 Association of Physician Specialists or the American Board of 163 Medical Specialties or an osteopathic physician who holds a 164 certificate in Pain Management by the American Osteopathic 165 Association. 166 (d) “Board eligible” means successful completion of an 167 anesthesia, physical medicine and rehabilitation, rheumatology, 168 or neurology residency program approved by the Accreditation 169 Council for Graduate Medical Education or the American 170 Osteopathic Association for a period of 6 years from successful 171 completion of such residency program. 172 (e) “Chronic nonmalignant pain” means pain unrelated to 173 cancer which persists beyond the usual course of disease or the 174 injury that is the cause of the pain or more than 90 days after 175 surgery. 176 (f) “Mental health addiction facility” means a facility 177 licensed under chapter 394 or chapter 397. 178 (g) “Registrant” means a physician, a physician assistant, 179 or an advanced registered nurse practitioner who meets the 180 requirements of subsection (2). 181 (2) REGISTRATION.—Effective January 1, 2012,A physician 182 licensed under chapter 458, chapter 459, chapter 461, or chapter 183 466, a physician assistant licensed under chapter 458 or chapter 184 459, or an advanced registered nurse practitioner certified 185 under part I of chapter 464 who prescribes any controlled 186 substance, listed in Schedule II, Schedule III, or Schedule IV 187 as defined in s. 893.03, for the treatment of chronic 188 nonmalignant pain, must: 189 (a) Designate himself or herself as a controlled substance 190 prescribing practitioner on his or herthe physician’s191 practitioner profile. 192 (b) Comply with the requirements of this section and 193 applicable board rules. 194 (3) STANDARDS OF PRACTICE.—The standards of practice in 195 this section do not supersede the level of care, skill, and 196 treatment recognized in general law related to health care 197 licensure. 198 (a) A complete medical history and a physical examination 199 must be conducted before beginning any treatment and must be 200 documented in the medical record. The exact components of the 201 physical examination shall be left to the judgment of the 202 registrantclinicianwho is expected to perform a physical 203 examination proportionate to the diagnosis that justifies a 204 treatment. The medical record must, at a minimum, document the 205 nature and intensity of the pain, current and past treatments 206 for pain, underlying or coexisting diseases or conditions, the 207 effect of the pain on physical and psychological function, a 208 review of previous medical records, previous diagnostic studies, 209 and history of alcohol and substance abuse. The medical record 210 shall also document the presence of one or more recognized 211 medical indications for the use of a controlled substance. Each 212 registrant must develop a written plan for assessing each 213 patient’s risk of aberrant drug-related behavior, which may 214 include patient drug testing. Registrants must assess each 215 patient’s risk for aberrant drug-related behavior and monitor 216 that risk on an ongoing basis in accordance with the plan. 217 (b) Each registrant must develop a written individualized 218 treatment plan for each patient. The treatment plan shall state 219 objectives that will be used to determine treatment success, 220 such as pain relief and improved physical and psychosocial 221 function, and shall indicate if any further diagnostic 222 evaluations or other treatments are planned. After treatment 223 begins, the registrantphysicianshall adjust drug therapy to 224 the individual medical needs of each patient. Other treatment 225 modalities, including a rehabilitation program, shall be 226 considered depending on the etiology of the pain and the extent 227 to which the pain is associated with physical and psychosocial 228 impairment. The interdisciplinary nature of the treatment plan 229 shall be documented. 230 (c) The registrantphysicianshall discuss the risks and 231 benefits of the use of controlled substances, including the 232 risks of abuse and addiction, as well as physical dependence and 233 its consequences, with the patient, persons designated by the 234 patient, or the patient’s surrogate or guardian if the patient 235 is incompetent. The registrantphysicianshall use a written 236 controlled substance agreement between the registrantphysician237 and the patient outlining the patient’s responsibilities, 238 including, but not limited to: 239 1. Number and frequency of controlled substance 240 prescriptions and refills. 241 2. Patient compliance and reasons for which drug therapy 242 may be discontinued, such as a violation of the agreement. 243 3. An agreement that controlled substances for the 244 treatment of chronic nonmalignant pain shall be prescribed by a 245 single treating registrantphysicianunless otherwise authorized 246 by the treating registrantphysicianand documented in the 247 medical record. 248 (d) The patient shall be seen by the registrantphysician249 at regular intervals, not to exceed 3 months, to assess the 250 efficacy of treatment, ensure that controlled substance therapy 251 remains indicated, evaluate the patient’s progress toward 252 treatment objectives, consider adverse drug effects, and review 253 the etiology of the pain. Continuation or modification of 254 therapy shall depend on the registrant’sphysician’sevaluation 255 of the patient’s progress. If treatment goals are not being 256 achieved, despite medication adjustments, the registrant 257physicianshall reevaluate the appropriateness of continued 258 treatment. The registrantphysicianshall monitor patient 259 compliance in medication usage, related treatment plans, 260 controlled substance agreements, and indications of substance 261 abuse or diversion at a minimum of 3-month intervals. 262 (e) The registrantphysicianshall refer the patient as 263 necessary for additional evaluation and treatment in order to 264 achieve treatment objectives. Special attention shall be given 265 to those patients who are at risk for misusing their medications 266 and those whose living arrangements pose a risk for medication 267 misuse or diversion. The management of pain in patients with a 268 history of substance abuse or with a comorbid psychiatric 269 disorder requires extra care, monitoring, and documentation and 270 requires consultation with or referral to an addiction medicine 271 specialist or a psychiatrist. 272 (f) A registrantphysicianregistered under this section273 must maintain accurate, current, and complete records that are 274 accessible and readily available for review and comply with the 275 requirements of this section, the applicable practice act, and 276 applicable board rules. The medical records must include, but 277 are not limited to: 278 1. The complete medical history and a physical examination, 279 including history of drug abuse or dependence. 280 2. Diagnostic, therapeutic, and laboratory results. 281 3. Evaluations and consultations. 282 4. Treatment objectives. 283 5. Discussion of risks and benefits. 284 6. Treatments. 285 7. Medications, including date, type, dosage, and quantity 286 prescribed. 287 8. Instructions and agreements. 288 9. Periodic reviews. 289 10. Results of any drug testing. 290 11. A photocopy of the patient’s government-issued photo 291 identification. 292 12. If a written prescription for a controlled substance is 293 given to the patient, a duplicate of the prescription. 294 13. The registrant’sphysician’sfull name presented in a 295 legible manner. 296 (g) A registrant shall immediately refer patients with 297 signs or symptoms of substance abuseshall be immediately298referredto a board-certified pain management physician, an 299 addiction medicine specialist, or a mental health addiction 300 facility as it pertains to drug abuse or addiction unless the 301 registrant is a physician who is board-certified or board 302 eligible in pain management. Throughout the period of time 303 before receiving the consultant’s report, a prescribing 304 registrantphysicianshall clearly and completely document 305 medical justification for continued treatment with controlled 306 substances and those steps taken to ensure medically appropriate 307 use of controlled substances by the patient. Upon receipt of the 308 consultant’s written report, the prescribing registrant 309physicianshall incorporate the consultant’s recommendations for 310 continuing, modifying, or discontinuing controlled substance 311 therapy. The resulting changes in treatment shall be 312 specifically documented in the patient’s medical record. 313 Evidence or behavioral indications of diversion shall be 314 followed by discontinuation of controlled substance therapy, and 315 the patient shall be discharged, and all results of testing and 316 actions taken by the registrantphysicianshall be documented in 317 the patient’s medical record. 318 319 This subsection does not apply to a board-eligible or board 320 certified anesthesiologist, physiatrist, rheumatologist, or 321 neurologist, or to a board-certified physician who has surgical 322 privileges at a hospital or ambulatory surgery center and 323 primarily provides surgical services. This subsection does not 324 apply to a board-eligible or board-certified medical specialist 325 who has also completed a fellowship in pain medicine approved by 326 the Accreditation Council for Graduate Medical Education or the 327 American Osteopathic Association, or who is board eligible or 328 board certified in pain medicine by the American Board of Pain 329 Medicine, the American Board of Interventional Pain Physicians, 330 the American Association of Physician Specialists, or a board 331 approved by the American Board of Medical Specialties or the 332 American Osteopathic Association and performs interventional 333 pain procedures of the type routinely billed using surgical 334 codes. This subsection does not apply to a registrantphysician335 who prescribes medically necessary controlled substances for a 336 patient during an inpatient stay in a hospital licensed under 337 chapter 395. 338 Section 107. Paragraph (b) of subsection (2) of section 339 458.3265, Florida Statutes, is amended to read: 340 458.3265 Pain-management clinics.— 341 (2) PHYSICIAN RESPONSIBILITIES.—These responsibilities 342 apply to any physician who provides professional services in a 343 pain-management clinic that is required to be registered in 344 subsection (1). 345 (b) Onlya person may not dispense any medication on the346premises of a registered pain-management clinic unless he or she347isa physician licensed under this chapter or chapter 459 may 348 dispense medication or prescribe a controlled substance 349 regulated under chapter 893 on the premises of a registered 350 pain-management clinic. 351 Section 108. Paragraph (b) of subsection (2) of section 352 459.0137, Florida Statutes, is amended to read: 353 459.0137 Pain-management clinics.— 354 (2) PHYSICIAN RESPONSIBILITIES.—These responsibilities 355 apply to any osteopathic physician who provides professional 356 services in a pain-management clinic that is required to be 357 registered in subsection (1). 358 (b) Onlya person may not dispense any medication on the359premises of a registered pain-management clinic unless he or she360isa physician licensed under this chapter or chapter 458 may 361 dispense medication or prescribe a controlled substance 362 regulated under chapter 893 on the premises of a registered 363 pain-management clinic. 364 Section 109. Paragraph (e) of subsection (4) of section 365 458.347, Florida Statutes, is amended, and paragraph (c) of 366 subsection (9) of that section is republished, to read: 367 458.347 Physician assistants.— 368 (4) PERFORMANCE OF PHYSICIAN ASSISTANTS.— 369 (e) A supervisory physician may delegate to a fully 370 licensed physician assistant the authority to prescribe or 371 dispense any medication used in the supervisory physician’s 372 practice unless such medication is listed on the formulary 373 created pursuant to paragraph (f). A fully licensed physician 374 assistant may only prescribe or dispense such medication under 375 the following circumstances: 376 1. A physician assistant must clearly identify to the 377 patient that he or she is a physician assistant. Furthermore, 378 the physician assistant must inform the patient that the patient 379 has the right to see the physician prior to any prescription 380 being prescribed or dispensed by the physician assistant. 381 2. The supervisory physician must notify the department of 382 his or her intent to delegate, on a department-approved form, 383 before delegating such authority and notify the department of 384 any change in prescriptive privileges of the physician 385 assistant. Authority to dispense may be delegated only by a 386 supervising physician who is registered as a dispensing 387 practitioner in compliance with s. 465.0276. 388 3. The physician assistant must file with the department a 389 signed affidavit that he or she has completed a minimum of 10 390 continuing medical education hours in the specialty practice in 391 which the physician assistant has prescriptive privileges with 392 each licensure renewal application. Three of the 10 hours must 393 consist of a continuing education course on the safe and 394 effective prescribing of controlled substance medications which 395 is offered by a statewide professional association of physicians 396 in this state accredited to provide educational activities 397 designated for the American Medical Association Physician’s 398 Recognition Award Category 1 credit or designated by the 399 American Academy of Physician Assistants as a Category 1 credit. 400 4. The department may issue a prescriber number to the 401 physician assistant granting authority for the prescribing of 402 medicinal drugs authorized within this paragraph upon completion 403 of the foregoing requirements. The physician assistant shall not 404 be required to independently register pursuant to s. 465.0276. 405 5. The prescription must be written in a form that complies 406 with chapter 499 and must contain, in addition to the 407 supervisory physician’s name, address, and telephone number, the 408 physician assistant’s prescriber number. Unless it is a drug or 409 drug sample dispensed by the physician assistant, the 410 prescription must be filled in a pharmacy permitted under 411 chapter 465 and must be dispensed in that pharmacy by a 412 pharmacist licensed under chapter 465. The appearance of the 413 prescriber number creates a presumption that the physician 414 assistant is authorized to prescribe the medicinal drug and the 415 prescription is valid. 416 6. The physician assistant must note the prescription or 417 dispensing of medication in the appropriate medical record. 418 (9) COUNCIL ON PHYSICIAN ASSISTANTS.—The Council on 419 Physician Assistants is created within the department. 420 (c) The council shall: 421 1. Recommend to the department the licensure of physician 422 assistants. 423 2. Develop all rules regulating the use of physician 424 assistants by physicians under this chapter and chapter 459, 425 except for rules relating to the formulary developed under 426 paragraph (4)(f). The council shall also develop rules to ensure 427 that the continuity of supervision is maintained in each 428 practice setting. The boards shall consider adopting a proposed 429 rule developed by the council at the regularly scheduled meeting 430 immediately following the submission of the proposed rule by the 431 council. A proposed rule submitted by the council may not be 432 adopted by either board unless both boards have accepted and 433 approved the identical language contained in the proposed rule. 434 The language of all proposed rules submitted by the council must 435 be approved by both boards pursuant to each respective board’s 436 guidelines and standards regarding the adoption of proposed 437 rules. If either board rejects the council’s proposed rule, that 438 board must specify its objection to the council with 439 particularity and include any recommendations it may have for 440 the modification of the proposed rule. 441 3. Make recommendations to the boards regarding all matters 442 relating to physician assistants. 443 4. Address concerns and problems of practicing physician 444 assistants in order to improve safety in the clinical practices 445 of licensed physician assistants. 446 Section 110. Effective January 1, 2017, paragraph (f) of 447 subsection (4) of section 458.347, Florida Statutes, is amended 448 to read: 449 458.347 Physician assistants.— 450 (4) PERFORMANCE OF PHYSICIAN ASSISTANTS.— 451 (f)1. The council shall establish a formulary of medicinal 452 drugs that a fully licensed physician assistant having 453 prescribing authority under this section or s. 459.022 may not 454 prescribe. The formulary must includecontrolled substances as455defined in chapter 893,general anesthetics,and radiographic 456 contrast materials and must limit the prescription of Schedule 457 II controlled substances as listed in s. 893.03 to a 7-day 458 supply. The formulary must also restrict the prescribing of 459 psychiatric mental health controlled substances for children 460 younger than 18 years of age. 461 2. In establishing the formulary, the council shall consult 462 with a pharmacist licensed under chapter 465, but not licensed 463 under this chapter or chapter 459, who shall be selected by the 464 State Surgeon General. 465 3. Only the council shall add to, delete from, or modify 466 the formulary. Any person who requests an addition, a deletion, 467 or a modification of a medicinal drug listed on such formulary 468 has the burden of proof to show cause why such addition, 469 deletion, or modification should be made. 470 4. The boards shall adopt the formulary required by this 471 paragraph, and each addition, deletion, or modification to the 472 formulary, by rule. Notwithstanding any provision of chapter 120 473 to the contrary, the formulary rule shall be effective 60 days 474 after the date it is filed with the Secretary of State. Upon 475 adoption of the formulary, the department shall mail a copy of 476 such formulary to each fully licensed physician assistant having 477 prescribing authority under this section or s. 459.022, and to 478 each pharmacy licensed by the state. The boards shall establish, 479 by rule, a fee not to exceed $200 to fund the provisions of this 480 paragraph and paragraph (e). 481 Section 111. Subsection (2) of section 464.003, Florida 482 Statutes, is amended to read: 483 464.003 Definitions.—As used in this part, the term: 484 (2) “Advanced or specialized nursing practice” means, in 485 addition to the practice of professional nursing, the 486 performance of advanced-level nursing acts approved by the board 487 which, by virtue of postbasic specialized education, training, 488 and experience, are appropriately performed by an advanced 489 registered nurse practitioner. Within the context of advanced or 490 specialized nursing practice, the advanced registered nurse 491 practitioner may perform acts of nursing diagnosis and nursing 492 treatment of alterations of the health status. The advanced 493 registered nurse practitioner may also perform acts of medical 494 diagnosis and treatment, prescription, and operation as 495 authorized within the framework of an established supervisory 496 protocolwhich are identified and approved by a joint committee497composed of three members appointed by the Board of Nursing, two498of whom must be advanced registered nurse practitioners; three499members appointed by the Board of Medicine, two of whom must500have had work experience with advanced registered nurse501practitioners; and the State Surgeon General or the State502Surgeon General’s designee.Each committee member appointed by a503board shall be appointed to a term of 4 years unless a shorter504term is required to establish or maintain staggered terms. The505Board of Nursing shall adopt rules authorizing the performance506of any such acts approved by the joint committee. Unless507otherwise specified by the joint committee, such acts must be508performed under the general supervision of a practitioner509licensed under chapter 458, chapter 459, or chapter 466 within510the framework of standing protocols which identify the medical511acts to be performed and the conditions for their performance.512 The department may, by rule, require that a copy of the protocol 513 be filed with the department along with the notice required by 514 s. 458.348. 515 Section 112. Section 464.012, Florida Statutes, is amended 516 to read: 517 464.012 Certification of advanced registered nurse 518 practitioners; fees; controlled substance prescribing.— 519 (1) Any nurse desiring to be certified as an advanced 520 registered nurse practitioner shall apply to the department and 521 submit proof that he or she holds a current license to practice 522 professional nursing and that he or she meets one or more of the 523 following requirements as determined by the board: 524 (a) Satisfactory completion of a formal postbasic 525 educational program of at least one academic year, the primary 526 purpose of which is to prepare nurses for advanced or 527 specialized practice. 528 (b) Certification by an appropriate specialty board. Such 529 certification shall be required for initial state certification 530 and any recertification as a registered nurse anesthetist or 531 nurse midwife. The board may by rule provide for provisional 532 state certification of graduate nurse anesthetists and nurse 533 midwives for a period of time determined to be appropriate for 534 preparing for and passing the national certification 535 examination. 536 (c) Graduation from a program leading to a master’s degree 537 in a nursing clinical specialty area with preparation in 538 specialized practitioner skills. For applicants graduating on or 539 after October 1, 1998, graduation from a master’s degree program 540 shall be required for initial certification as a nurse 541 practitioner under paragraph (4)(c). For applicants graduating 542 on or after October 1, 2001, graduation from a master’s degree 543 program shall be required for initial certification as a 544 registered nurse anesthetist under paragraph (4)(a). 545 (2) The board shall provide by rule the appropriate 546 requirements for advanced registered nurse practitioners in the 547 categories of certified registered nurse anesthetist, certified 548 nurse midwife, and nurse practitioner. 549 (3) An advanced registered nurse practitioner shall perform 550 those functions authorized in this section within the framework 551 of an established protocol that is filed with the board upon 552 biennial license renewal and within 30 days after entering into 553 a supervisory relationship with a physician or changes to the 554 protocol. The board shall review the protocol to ensure 555 compliance with applicable regulatory standards for protocols. 556 The board shall refer to the department licensees submitting 557 protocols that are not compliant with the regulatory standards 558 for protocols. A practitioner currently licensed under chapter 559 458, chapter 459, or chapter 466 shall maintain supervision for 560 directing the specific course of medical treatment. Within the 561 established framework, an advanced registered nurse practitioner 562 may: 563 (a) Monitor and alter drug therapies. 564 (b) Initiate appropriate therapies for certain conditions. 565 (c) Perform additional functions as may be determined by 566 rule in accordance with s. 464.003(2). 567 (d) Order diagnostic tests and physical and occupational 568 therapy. 569 (4) In addition to the general functions specified in 570 subsection (3), an advanced registered nurse practitioner may 571 perform the following acts within his or her specialty: 572 (a) The certified registered nurse anesthetist may, to the 573 extent authorized by established protocol approved by the 574 medical staff of the facility in which the anesthetic service is 575 performed, perform any or all of the following: 576 1. Determine the health status of the patient as it relates 577 to the risk factors and to the anesthetic management of the 578 patient through the performance of the general functions. 579 2. Based on history, physical assessment, and supplemental 580 laboratory results, determine, with the consent of the 581 responsible physician, the appropriate type of anesthesia within 582 the framework of the protocol. 583 3. Order under the protocol preanesthetic medication. 584 4. Perform under the protocol procedures commonly used to 585 render the patient insensible to pain during the performance of 586 surgical, obstetrical, therapeutic, or diagnostic clinical 587 procedures. These procedures include ordering and administering 588 regional, spinal, and general anesthesia; inhalation agents and 589 techniques; intravenous agents and techniques; and techniques of 590 hypnosis. 591 5. Order or perform monitoring procedures indicated as 592 pertinent to the anesthetic health care management of the 593 patient. 594 6. Support life functions during anesthesia health care, 595 including induction and intubation procedures, the use of 596 appropriate mechanical supportive devices, and the management of 597 fluid, electrolyte, and blood component balances. 598 7. Recognize and take appropriate corrective action for 599 abnormal patient responses to anesthesia, adjunctive medication, 600 or other forms of therapy. 601 8. Recognize and treat a cardiac arrhythmia while the 602 patient is under anesthetic care. 603 9. Participate in management of the patient while in the 604 postanesthesia recovery area, including ordering the 605 administration of fluids and drugs. 606 10. Place special peripheral and central venous and 607 arterial lines for blood sampling and monitoring as appropriate. 608 (b) The certified nurse midwife may, to the extent 609 authorized by an established protocol which has been approved by 610 the medical staff of the health care facility in which the 611 midwifery services are performed, or approved by the nurse 612 midwife’s physician backup when the delivery is performed in a 613 patient’s home, perform any or all of the following: 614 1. Perform superficial minor surgical procedures. 615 2. Manage the patient during labor and delivery to include 616 amniotomy, episiotomy, and repair. 617 3. Order, initiate, and perform appropriate anesthetic 618 procedures. 619 4. Perform postpartum examination. 620 5. Order appropriate medications. 621 6. Provide family-planning services and well-woman care. 622 7. Manage the medical care of the normal obstetrical 623 patient and the initial care of a newborn patient. 624 (c) The nurse practitioner may perform any or all of the 625 following acts within the framework of established protocol: 626 1. Manage selected medical problems. 627 2. Order physical and occupational therapy. 628 3. Initiate, monitor, or alter therapies for certain 629 uncomplicated acute illnesses. 630 4. Monitor and manage patients with stable chronic 631 diseases. 632 5. Establish behavioral problems and diagnosis and make 633 treatment recommendations. 634 (5) The board shall certify, and the department shall issue 635 a certificate to, any nurse meeting the qualifications in this 636 section. The board shall establish an application fee not to 637 exceed $100 and a biennial renewal fee not to exceed $50. The 638 board is authorized to adopt such other rules as are necessary 639 to implement the provisions of this section. 640 (6)(a) The board shall establish a committee to recommend a 641 formulary of controlled substances that an advanced registered 642 nurse practitioner may not prescribe or may prescribe only for 643 specific uses or in limited quantities. The committee must 644 consist of three advanced registered nurse practitioners 645 licensed under this section, recommended by the board; three 646 physicians licensed under chapter 458 or chapter 459 who have 647 work experience with advanced registered nurse practitioners, 648 recommended by the Board of Medicine; and a pharmacist licensed 649 under chapter 465 who is a doctor of pharmacy, recommended by 650 the Board of Pharmacy. The committee may recommend an evidence 651 based formulary applicable to all advanced registered nurse 652 practitioners which is limited by specialty certification, is 653 limited to approved uses of controlled substances, or is subject 654 to other similar restrictions the committee finds are necessary 655 to protect the health, safety, and welfare of the public. The 656 formulary must restrict the prescribing of psychiatric mental 657 health controlled substances for children younger than 18 years 658 of age to advanced registered nurse practitioners who also are 659 psychiatric nurses as defined in s. 394.455. The formulary must 660 also limit the prescribing of Schedule II controlled substances 661 as listed in s. 893.03 to a 7-day supply, except that such 662 restriction does not apply to controlled substances that are 663 psychiatric medications prescribed by psychiatric nurses as 664 defined in s. 394.455. 665 (b) The board shall adopt by rule the recommended formulary 666 and any revision to the formulary which it finds is supported by 667 evidence-based clinical findings presented by the Board of 668 Medicine, the Board of Osteopathic Medicine, or the Board of 669 Dentistry. 670 (c) The formulary required under this subsection does not 671 apply to a controlled substance that is dispensed for 672 administration pursuant to an order, including an order for 673 medication authorized by subparagraph (4)(a)3., subparagraph 674 (4)(a)4., or subparagraph (4)(a)9. 675 (d) The board shall adopt the committee’s initial 676 recommendation no later than October 31, 2016. 677 (7) This section shall be known as “The Barbara Lumpkin 678 Prescribing Act.” 679 Section 113. Effective January 1, 2017, subsection (3) of 680 section 464.012, Florida Statutes, as amended by this act, is 681 amended to read: 682 464.012 Certification of advanced registered nurse 683 practitioners; fees; controlled substance prescribing.— 684 (3) An advanced registered nurse practitioner shall perform 685 those functions authorized in this section within the framework 686 of an established protocol that is filed with the board upon 687 biennial license renewal and within 30 days after entering into 688 a supervisory relationship with a physician or changes to the 689 protocol. The board shall review the protocol to ensure 690 compliance with applicable regulatory standards for protocols. 691 The board shall refer to the department licensees submitting 692 protocols that are not compliant with the regulatory standards 693 for protocols. A practitioner currently licensed under chapter 694 458, chapter 459, or chapter 466 shall maintain supervision for 695 directing the specific course of medical treatment. Within the 696 established framework, an advanced registered nurse practitioner 697 may: 698 (a) Prescribe, dispense, administer, or order any drug; 699 however, an advanced registered nurse practitioner may prescribe 700 or dispense a controlled substance as defined in s. 893.03 only 701 if the advanced registered nurse practitioner has graduated from 702 a program leading to a master’s or doctoral degree in a clinical 703 nursing specialty area with training in specialized practitioner 704 skillsMonitor and alter drug therapies. 705 (b) Initiate appropriate therapies for certain conditions. 706 (c) Perform additional functions as may be determined by 707 rule in accordance with s. 464.003(2). 708 (d) Order diagnostic tests and physical and occupational 709 therapy. 710 Section 114. Subsection (3) of section 464.013, Florida 711 Statutes, is amended to read: 712 464.013 Renewal of license or certificate.— 713 (3) The board shall by rule prescribe up to 30 hours of 714 continuing education biennially as a condition for renewal of a 715 license or certificate. 716 (a) A nurse who is certified by a health care specialty 717 program accredited by the National Commission for Certifying 718 Agencies or the Accreditation Board for Specialty Nursing 719 Certification is exempt from continuing education requirements. 720 The criteria for programs mustshallbe approved by the board. 721 (b) Notwithstanding the exemption in paragraph (a), as part 722 of the maximum 30 hours of continuing education hours required 723 under this subsection, advanced registered nurse practitioners 724 certified under s. 464.012 must complete at least 3 hours of 725 continuing education on the safe and effective prescription of 726 controlled substances. Such continuing education courses must be 727 offered by a statewide professional association of physicians in 728 this state accredited to provide educational activities 729 designated for the American Medical Association Physician’s 730 Recognition Award Category 1 credit, the American Nurses 731 Credentialing Center, the American Association of Nurse 732 Anesthetists, or the American Association of Nurse Practitioners 733 and may be offered in a distance learning format. 734 Section 115. Paragraph (p) is added to subsection (1) of 735 section 464.018, Florida Statutes, and subsection (2) of that 736 section is republished, to read: 737 464.018 Disciplinary actions.— 738 (1) The following acts constitute grounds for denial of a 739 license or disciplinary action, as specified in s. 456.072(2): 740 (p) For an advanced registered nurse practitioner: 741 1. Presigning blank prescription forms. 742 2. Prescribing for office use any medicinal drug appearing 743 on Schedule II in chapter 893. 744 3. Prescribing, ordering, dispensing, administering, 745 supplying, selling, or giving a drug that is an amphetamine, a 746 sympathomimetic amine drug, or a compound designated in s. 747 893.03(2) as a Schedule II controlled substance, to or for any 748 person except for: 749 a. The treatment of narcolepsy; hyperkinesis; behavioral 750 syndrome in children characterized by the developmentally 751 inappropriate symptoms of moderate to severe distractibility, 752 short attention span, hyperactivity, emotional lability, and 753 impulsivity; or drug-induced brain dysfunction. 754 b. The differential diagnostic psychiatric evaluation of 755 depression or the treatment of depression shown to be refractory 756 to other therapeutic modalities. 757 c. The clinical investigation of the effects of such drugs 758 or compounds when an investigative protocol is submitted to, 759 reviewed by, and approved by the department before such 760 investigation is begun. 761 4. Prescribing, ordering, dispensing, administering, 762 supplying, selling, or giving growth hormones, testosterone or 763 its analogs, human chorionic gonadotropin (HCG), or other 764 hormones for the purpose of muscle building or to enhance 765 athletic performance. As used in this subparagraph, the term 766 “muscle building” does not include the treatment of injured 767 muscle. A prescription written for the drug products identified 768 in this subparagraph may be dispensed by a pharmacist with the 769 presumption that the prescription is for legitimate medical use. 770 5. Promoting or advertising on any prescription form a 771 community pharmacy unless the form also states: “This 772 prescription may be filled at any pharmacy of your choice.” 773 6. Prescribing, dispensing, administering, mixing, or 774 otherwise preparing a legend drug, including a controlled 775 substance, other than in the course of his or her professional 776 practice. For the purposes of this subparagraph, it is legally 777 presumed that prescribing, dispensing, administering, mixing, or 778 otherwise preparing legend drugs, including all controlled 779 substances, inappropriately or in excessive or inappropriate 780 quantities is not in the best interest of the patient and is not 781 in the course of the advanced registered nurse practitioner’s 782 professional practice, without regard to his or her intent. 783 7. Prescribing, dispensing, or administering a medicinal 784 drug appearing on any schedule set forth in chapter 893 to 785 himself or herself, except a drug prescribed, dispensed, or 786 administered to the advanced registered nurse practitioner by 787 another practitioner authorized to prescribe, dispense, or 788 administer medicinal drugs. 789 8. Prescribing, ordering, dispensing, administering, 790 supplying, selling, or giving amygdalin (laetrile) to any 791 person. 792 9. Dispensing a substance designated in s. 893.03(2) or (3) 793 as a controlled substance listed in Schedule II or Schedule III, 794 respectively, in violation of s. 465.0276. 795 10. Promoting or advertising through any communication 796 medium the use, sale, or dispensing of a substance designated in 797 s. 893.03 as a controlled substance. 798 (2) The board may enter an order denying licensure or 799 imposing any of the penalties in s. 456.072(2) against any 800 applicant for licensure or licensee who is found guilty of 801 violating any provision of subsection (1) of this section or who 802 is found guilty of violating any provision of s. 456.072(1). 803 Section 116. Paragraph (a) of subsection (3) of section 804 766.1115, Florida Statutes, is amended to read: 805 766.1115 Health care providers; creation of agency 806 relationship with governmental contractors.— 807 (3) DEFINITIONS.—As used in this section, the term: 808 (a) “Contract” means an agreement executed in compliance 809 with this section between a health care provider and a 810 governmental contractor for volunteer, uncompensated services 811 which allows the health care provider to deliver health care 812 services to low-income recipients as an agent of the 813 governmental contractor.The contract must be for volunteer,814uncompensated services,except as provided in paragraph (4)(g).815 For services to qualify as volunteer, uncompensated services 816 under this section, the health care provider, or any employee or 817 agent of the health care provider, must receive no compensation 818 from the governmental contractor for any services provided under 819 the contract and must not bill or accept compensation from the 820 recipient, or a public or private third-party payor, for the 821 specific services provided to the low-income recipients covered 822 by the contract, except as provided in paragraph (4)(g). A free 823 clinic as described in subparagraph (d)14. may receive a 824 legislative appropriation, a grant through a legislative 825 appropriation, or a grant from a governmental entity or 826 nonprofit corporation to support the delivery of contracted 827 services by volunteer health care providers, including the 828 employment of health care providers to supplement, coordinate, 829 or support the delivery of such services. The appropriation or 830 grant for the free clinic does not constitute compensation under 831 this paragraph from the governmental contractor for services 832 provided under the contract, nor does receipt or use of the 833 appropriation or grant constitute the acceptance of compensation 834 under this paragraph for the specific services provided to the 835 low-income recipients covered by the contract. 836 Section 117. Subsection (21) of section 893.02, Florida 837 Statutes, is amended to read: 838 893.02 Definitions.—The following words and phrases as used 839 in this chapter shall have the following meanings, unless the 840 context otherwise requires: 841 (21) “Practitioner” means a physician licensed under 842pursuant tochapter 458, a dentist licensed underpursuant to843 chapter 466, a veterinarian licensed underpursuant tochapter 844 474, an osteopathic physician licensed underpursuant tochapter 845 459, an advanced registered nurse practitioner certified under 846 chapter 464, a naturopath licensed underpursuant tochapter 847 462, a certified optometrist licensed underpursuant tochapter 848 463,ora podiatric physician licensed underpursuant tochapter 849 461, or a physician assistant licensed under chapter 458 or 850 chapter 459, provided such practitioner holds a valid federal 851 controlled substance registry number. 852 Section 118. Paragraph (n) of subsection (1) of section 853 948.03, Florida Statutes, is amended to read: 854 948.03 Terms and conditions of probation.— 855 (1) The court shall determine the terms and conditions of 856 probation. Conditions specified in this section do not require 857 oral pronouncement at the time of sentencing and may be 858 considered standard conditions of probation. These conditions 859 may include among them the following, that the probationer or 860 offender in community control shall: 861 (n) Be prohibited from using intoxicants to excess or 862 possessing any drugs or narcotics unless prescribed by a 863 physician, an advanced registered nurse practitioner, or a 864 physician assistant. The probationer or community controllee may 865shallnot knowingly visit places where intoxicants, drugs, or 866 other dangerous substances are unlawfully sold, dispensed, or 867 used. 868 Section 119. Paragraph (a) of subsection (1) and subsection 869 (2) of section 458.348, Florida Statutes, are amended to read: 870 458.348 Formal supervisory relationships, standing orders, 871 and established protocols; notice; standards.— 872 (1) NOTICE.— 873 (a) When a physician enters into a formal supervisory 874 relationship or standing orders with an emergency medical 875 technician or paramedic licensed pursuant to s. 401.27, which 876 relationship or orders contemplate the performance of medical 877 acts, or when a physician enters into an established protocol 878 with an advanced registered nurse practitioner, which protocol 879 contemplates the performance of medicalacts identified and880approved by the joint committee pursuant to s. 464.003(2) or881 acts set forth in s. 464.012(3) and (4), the physician shall 882 submit notice to the board. The notice shall contain a statement 883 in substantially the following form: 884 885 I, ...(name and professional license number of 886 physician)..., of ...(address of physician)... have hereby 887 entered into a formal supervisory relationship, standing orders, 888 or an established protocol with ...(number of persons)... 889 emergency medical technician(s), ...(number of persons)... 890 paramedic(s), or ...(number of persons)... advanced registered 891 nurse practitioner(s). 892 893 (2) ESTABLISHMENT OF STANDARDS BY JOINT COMMITTEE.—The 894 joint committeecreated under s. 464.003(2)shall determine 895 minimum standards for the content of established protocols 896 pursuant to which an advanced registered nurse practitioner may 897 perform medical actsidentified and approved by the joint898committee pursuant to s. 464.003(2)or acts set forth in s. 899 464.012(3) and (4) and shall determine minimum standards for 900 supervision of such acts by the physician, unless the joint 901 committee determines that any act set forth in s. 464.012(3) or 902 (4) is not a medical act. Such standards shall be based on risk 903 to the patient and acceptable standards of medical care and 904 shall take into account the special problems of medically 905 underserved areas. The standards developed by the joint 906 committee shall be adopted as rules by the Board of Nursing and 907 the Board of Medicine for purposes of carrying out their 908 responsibilities pursuant to part I of chapter 464 and this 909 chapter, respectively, but neither board shall have disciplinary 910 powers over the licensees of the other board. 911 Section 120. Paragraph (a) of subsection (1) of section 912 459.025, Florida Statutes, is amended to read: 913 459.025 Formal supervisory relationships, standing orders, 914 and established protocols; notice; standards.— 915 (1) NOTICE.— 916 (a) When an osteopathic physician enters into a formal 917 supervisory relationship or standing orders with an emergency 918 medical technician or paramedic licensed pursuant to s. 401.27, 919 which relationship or orders contemplate the performance of 920 medical acts, or when an osteopathic physician enters into an 921 established protocol with an advanced registered nurse 922 practitioner, which protocol contemplates the performance of 923 medical actsidentified and approved by the joint committee924pursuant to s. 464.003(2)or acts set forth in s. 464.012(3) and 925 (4), the osteopathic physician shall submit notice to the board. 926 The notice must contain a statement in substantially the 927 following form: 928 929 I, ...(name and professional license number of osteopathic 930 physician)..., of ...(address of osteopathic physician)... have 931 hereby entered into a formal supervisory relationship, standing 932 orders, or an established protocol with ...(number of 933 persons)... emergency medical technician(s), ...(number of 934 persons)... paramedic(s), or ...(number of persons)... advanced 935 registered nurse practitioner(s). 936 Section 121. Subsection (10) of s. 458.331, paragraph (g) 937 of subsection (7) of s. 458.347, subsection (10) of s. 459.015, 938 paragraph (f) of subsection (7) of s. 459.022, and paragraph (b) 939 of subsection (5) of s. 465.0158, Florida Statutes, are 940 reenacted for the purpose of incorporating the amendment made by 941 this act to s. 456.072, Florida Statutes, in references thereto. 942 Section 122. Paragraph (mm) of subsection (1) of s. 456.072 943 and s. 466.02751, Florida Statutes, are reenacted for the 944 purpose of incorporating the amendment made by this act to s. 945 456.44, Florida Statutes, in references thereto. 946 Section 123. Section 458.303, paragraph (b) of subsection 947 (7) of s. 458.3475, paragraph (e) of subsection (4) and 948 paragraph (c) of subsection (9) of s. 459.022, and paragraph (b) 949 of subsection (7) of s. 459.023, Florida Statutes, are reenacted 950 for the purpose of incorporating the amendment made by this act 951 to s. 458.347, Florida Statutes, in references thereto. 952 Section 124. Paragraph (c) of subsection (3) of s. 464.012, 953 Florida Statutes, is reenacted for the purpose of incorporating 954 the amendment made by this act to s. 464.003, Florida Statutes, 955 in a reference thereto. 956 Section 125. Paragraph (a) of subsection (1) of s. 456.041, 957 subsections (1) and (2) of s. 458.348, and subsection (1) of s. 958 459.025, Florida Statutes, are reenacted for the purpose of 959 incorporating the amendment made by this act to s. 464.012, 960 Florida Statutes, in references thereto. 961 Section 126. Subsection (7) of s. 464.0205, Florida 962 Statutes, is reenacted for the purpose of incorporating the 963 amendment made by this act to s. 464.013, Florida Statutes, in a 964 reference thereto. 965 Section 127. Subsection (11) of s. 320.0848, subsection (2) 966 of s. 464.008, subsection (5) of s. 464.009, and paragraph (b) 967 of subsection (1), subsection (3), and paragraph (b) of 968 subsection (4) of s. 464.0205, Florida Statutes, are reenacted 969 for the purpose of incorporating the amendment made by this act 970 to s. 464.018, Florida Statutes, in references thereto. 971 Section 128. Section 775.051, Florida Statutes, is 972 reenacted for the purpose of incorporating the amendment made by 973 this act to s. 893.02, Florida Statutes, in a reference thereto. 974 Section 129. Paragraph (a) of subsection (3) of s. 944.17, 975 subsection (8) of s. 948.001, and paragraph (e) of subsection 976 (1) of s. 948.101, Florida Statutes, are reenacted for the 977 purpose of incorporating the amendment made by this act to s. 978 948.03, Florida Statutes, in references thereto. 979 Section 130. Except as otherwise expressly provided in this 980 act, this act shall take effect upon becoming a law. 981 982 ================= T I T L E A M E N D M E N T ================ 983 And the title is amended as follows: 984 Delete line 5263 985 and insert: 986 amending s. 110.12315, F.S.; expanding the categories 987 of persons who may prescribe brand name drugs under 988 the prescription drug program under certain 989 circumstances; amending ss. 310.071, 310.073, and 990 310.081, F.S.; exempting controlled substances 991 prescribed by an advanced registered nurse 992 practitioner or a physician assistant from the 993 disqualifications for certification or licensure, and 994 for continued certification or licensure, as a deputy 995 pilot or state pilot; amending s. 456.072, F.S.; 996 applying existing penalties for violations relating to 997 the prescribing or dispensing of controlled substances 998 by an advanced registered nurse practitioner; amending 999 s. 456.44, F.S.; defining the term “registrant”; 1000 deleting an obsolete date; requiring advanced 1001 registered nurse practitioners and physician 1002 assistants who prescribe controlled substances for the 1003 treatment of certain pain to make a certain 1004 designation, comply with registration requirements, 1005 and follow specified standards of practice; providing 1006 applicability; amending ss. 458.3265 and 459.0137, 1007 F.S.; limiting the authority to prescribe a controlled 1008 substance in a pain-management clinic only to a 1009 physician licensed under ch. 458, F.S., or ch. 459, 1010 F.S.; amending s. 458.347, F.S.; revising the required 1011 continuing education requirements for a physician 1012 assistant; requiring that a specified formulary limit 1013 the prescription of certain controlled substances by 1014 physician assistants as of a specified date; amending 1015 s. 464.003, F.S.; revising the term “advanced or 1016 specialized nursing practice”; deleting the joint 1017 committee established in the definition; amending s. 1018 464.012, F.S.; requiring the Board of Nursing to 1019 establish a committee to recommend a formulary of 1020 controlled substances that may not be prescribed, or 1021 may be prescribed only on a limited basis, by an 1022 advanced registered nurse practitioner; specifying the 1023 membership of the committee; providing parameters for 1024 the formulary; requiring that the formulary be adopted 1025 by board rule; specifying the process for amending the 1026 formulary and imposing a burden of proof; limiting the 1027 formulary’s application in certain instances; 1028 requiring the board to adopt the committee’s initial 1029 recommendations by a specified date; providing a short 1030 title; authorizing an advanced registered nurse 1031 practitioner to prescribe, dispense, administer, or 1032 order drugs, including certain controlled substances 1033 under certain circumstances, as of a specified date; 1034 amending s. 464.013, F.S.; revising continuing 1035 education requirements for renewal of a license or 1036 certificate; amending s. 464.018, F.S.; specifying 1037 acts that constitute grounds for denial of a license 1038 or for disciplinary action against an advanced 1039 registered nurse practitioner; amending s. 766.1115, 1040 F.S.; revising the definition of the term “contract”; 1041 amending s. 893.02, F.S.; revising the term 1042 “practitioner” to include advanced registered nurse 1043 practitioners and physician assistants under the 1044 Florida Comprehensive Drug Abuse Prevention and 1045 Control Act if a certain requirement is met; amending 1046 s. 948.03, F.S.; providing that possession of drugs or 1047 narcotics prescribed by an advanced registered nurse 1048 practitioner or a physician assistant does not violate 1049 a prohibition relating to the possession of drugs or 1050 narcotics during probation; amending ss. 458.348 and 1051 459.025, F.S.; conforming provisions to changes made 1052 by the act; reenacting ss. 458.331(10), 458.347(7)(g), 1053 459.015(10), 459.022(7)(f), and 465.0158(5)(b), F.S., 1054 to incorporate the amendment made to s. 456.072, F.S., 1055 in references thereto; reenacting ss. 456.072(1)(mm) 1056 and 466.02751, F.S., to incorporate the amendment made 1057 to s. 456.44, F.S., in references thereto; reenacting 1058 ss. 458.303, 458.3475(7)(b), 459.022(4)(e) and (9)(c), 1059 and 459.023(7)(b), F.S., to incorporate the amendment 1060 made to s. 458.347, F.S., in references thereto; 1061 reenacting s. 464.012(3)(c), F.S., to incorporate the 1062 amendment made to s. 464.003, F.S., in a reference 1063 thereto; reenacting ss. 456.041(1)(a), 458.348(1) and 1064 (2), and 459.025(1), F.S., to incorporate the 1065 amendment made to s. 464.012, F.S., in references 1066 thereto; reenacting s. 464.0205(7), F.S., to 1067 incorporate the amendment made to s. 464.013, F.S., in 1068 a reference thereto; reenacting ss. 320.0848(11), 1069 464.008(2), 464.009(5), and 464.0205(1)(b), (3), and 1070 (4)(b), F.S., to incorporate the amendment made to s. 1071 464.018, F.S., in references thereto; reenacting s. 1072 775.051, F.S., to incorporate the amendment made to s. 1073 893.02, F.S., in a reference thereto; reenacting ss. 1074 944.17(3)(a), 948.001(8), and 948.101(1)(e), F.S., to 1075 incorporate the amendment made to s. 948.03, F.S., in 1076 references thereto; providing effective dates.