Bill Text: FL S1676 | 2020 | Regular Session | Comm Sub


Bill Title: Direct Care Workers

Spectrum: Slight Partisan Bill (? 2-1)

Status: (Introduced) 2020-03-10 - Laid on Table, refer to CS/CS/HB 607 [S1676 Detail]

Download: Florida-2020-S1676-Comm_Sub.html
       Florida Senate - 2020                      CS for CS for SB 1676
       
       
        
       By the Committees on Appropriations; and Health Policy; and
       Senator Albritton
       
       
       
       
       576-04552-20                                          20201676c2
    1                        A bill to be entitled                      
    2         An act relating to direct care workers; amending s.
    3         400.141, F.S.; authorizing nursing home facilities to
    4         use paid feeding assistants in accordance with
    5         specified federal law under certain circumstances;
    6         providing training program requirements; authorizing
    7         the Agency for Health Care Administration to adopt
    8         rules; amending s. 400.23, F.S.; prohibiting the
    9         counting of paid feeding assistants toward compliance
   10         with minimum staffing standards; amending s. 400.461,
   11         F.S.; revising a short title; amending s. 400.462,
   12         F.S.; revising the definition of the term “home health
   13         aide”; amending s. 400.464, F.S.; requiring a licensed
   14         home health agency that authorizes a registered nurse
   15         to delegate tasks to a certified nursing assistant or
   16         a home health aide to ensure that certain requirements
   17         are met; amending s. 400.488, F.S.; authorizing an
   18         unlicensed person to assist with self-administration
   19         of certain treatments; revising the requirements for
   20         such assistance; creating s. 400.489, F.S.;
   21         authorizing home health aides to administer certain
   22         prescription medications under certain conditions;
   23         requiring such home health aides to meet certain
   24         training and competency requirements; requiring that
   25         the training, determination of competency, and annual
   26         validation of home health aides be conducted by a
   27         registered nurse or a physician; requiring home health
   28         aides to complete annual inservice training in
   29         medication administration and medication error
   30         prevention, in addition to existing annual inservice
   31         training requirements; requiring the agency, in
   32         consultation with the Board of Nursing, to establish
   33         by rule standards and procedures for medication
   34         administration by home health aides; providing
   35         requirements for such rules; creating s. 400.490,
   36         F.S.; authorizing certified nursing assistants or home
   37         health aides to perform certain tasks delegated by a
   38         registered nurse; creating s. 400.52, F.S.; creating
   39         the Excellence in Home Health Program within the
   40         agency for a specified purpose; requiring the agency
   41         to adopt rules establishing program criteria;
   42         providing requirements for such criteria; requiring
   43         the agency to annually evaluate certain home health
   44         agencies and nurse registries; providing program
   45         designation eligibility requirements; providing that a
   46         program designation is not transferable, with an
   47         exception; providing for the expiration of awarded
   48         designations; requiring home health agencies and nurse
   49         registries to biennially renew the awarded program
   50         designation; authorizing a program designation award
   51         recipient to use the designation in advertising and
   52         marketing; specifying circumstances under which a home
   53         health agency or nurse registry may not use a program
   54         designation in advertising or marketing; providing
   55         that an application submitted under the program is not
   56         an application for licensure; providing that certain
   57         actions by the agency are not subject to certain
   58         provisions; creating s. 408.822, F.S.; defining the
   59         term “direct care worker”; requiring certain licensees
   60         to provide specified information about their employees
   61         in a survey beginning on a specified date; requiring
   62         that the survey be completed on a form adopted by the
   63         agency by rule and include a specified attestation;
   64         requiring a licensee to submit such survey as a
   65         contingency of license renewal; requiring the agency
   66         to continually analyze the results of such surveys and
   67         publish the results on the agency’s website; requiring
   68         the agency to update such information monthly;
   69         creating s. 464.0156, F.S.; authorizing a registered
   70         nurse to delegate certain tasks to a certified nursing
   71         assistant or a home health aide under certain
   72         conditions; providing criteria that a registered nurse
   73         must consider in determining if a task may be
   74         delegated to a certified nursing assistant or a home
   75         health aide; authorizing a registered nurse to
   76         delegate prescription medication administration to a
   77         certified nursing assistant or a home health aide,
   78         subject to certain requirements; providing an
   79         exception for certain controlled substances; requiring
   80         the Board of Nursing, in consultation with the agency,
   81         to adopt rules; amending s. 464.018, F.S.; providing
   82         disciplinary action; creating s. 464.2035, F.S.;
   83         authorizing certified nursing assistants to administer
   84         certain prescription medications under certain
   85         conditions; requiring such certified nursing
   86         assistants to meet certain training and competency
   87         requirements; requiring the training, determination of
   88         competency, and annual validation of certified nursing
   89         assistants to be conducted by a registered nurse or a
   90         physician; requiring such certified nursing assistants
   91         to complete annual inservice training in medication
   92         administration and medication error prevention in
   93         addition to existing annual inservice training
   94         requirements; requiring the board, in consultation
   95         with the agency, to adopt by rule standards and
   96         procedures for medication administration by certified
   97         nursing assistants; creating s. 381.40185, F.S.;
   98         establishing the Physician Student Loan Repayment
   99         Program for a specified purpose; defining terms;
  100         requiring the Department of Health to establish the
  101         program; providing program eligibility requirements;
  102         providing for the award of funds from the program to
  103         repay the student loans of certain physicians;
  104         specifying circumstances under which a physician is no
  105         longer eligible to receive funds from the program;
  106         requiring the department to adopt rules; providing
  107         that implementation of the program is subject to a
  108         legislative appropriation; amending s. 464.003, F.S.;
  109         defining the term “advanced practice registered nurse
  110         - independent practitioner” (APRN-IP); creating s.
  111         464.0123, F.S.; creating the Patient Access to Primary
  112         Care Program for a specified purpose; requiring the
  113         department to implement the program; defining terms;
  114         creating the Council on Advanced Practice Registered
  115         Nurse Independent Practice within the department;
  116         providing council membership requirements, terms, and
  117         duties; requiring the council to develop certain
  118         proposed rules; providing for the adoption of the
  119         proposed rules; authorizing the council to enter an
  120         order to refuse to register an applicant or to approve
  121         an applicant for restricted registration or
  122         conditional registration under certain circumstances;
  123         providing registration and registration renewal
  124         requirements; requiring the department to update the
  125         practitioner’s profile to reflect specified
  126         information; providing limitations on the scope of
  127         practice of an APRN-IP; requiring the department to
  128         adopt specified rules related to the scope of practice
  129         for APRN-IPS; requiring APRN-IPs to report adverse
  130         incidents to the department within a specified
  131         timeframe; defining the term “adverse incident”;
  132         requiring the department to review adverse incidents
  133         and make specified determinations; providing for
  134         disciplinary action; requiring the department to adopt
  135         certain rules; providing for the reactivation of
  136         registration; providing construction; requiring the
  137         department to adopt rules; amending s. 464.015, F.S.;
  138         prohibiting unregistered persons from using the title
  139         or abbreviation of APRN-IP; amending s. 464.018, F.S.;
  140         providing additional grounds for denial of a license
  141         or disciplinary action for APRN-IPs; amending s.
  142         381.026, F.S.; revising the definition of the term
  143         “health care provider”; amending s. 382.008, F.S.;
  144         authorizing an APRN-IP to file a certificate of death
  145         or fetal death under certain circumstances; requiring
  146         an APRN-IP to provide certain information to a funeral
  147         director within a specified timeframe; defining the
  148         term “primary or attending practitioner”; conforming
  149         provisions to changes made by the act; amending s.
  150         382.011, F.S.; conforming a provision to changes made
  151         by the act; amending s. 394.463, F.S.; authorizing
  152         APRN-IPs to examine patients and initiate involuntary
  153         examinations for mental illness under certain
  154         circumstances; amending s. 397.501, F.S.; prohibiting
  155         service providers from denying an individual certain
  156         services under certain circumstances; amending s.
  157         456.053, F.S.; revising definitions; providing
  158         disciplinary action; conforming provisions to changes
  159         made by the act; amending s. 626.9707, F.S.;
  160         prohibiting an insurer from refusing to issue and
  161         deliver certain disability insurance policies that
  162         cover any medical treatment or service furnished by an
  163         advanced practice registered nurse or an APRN-IP;
  164         creating ss. 627.64025 and 627.6621, F.S.; prohibiting
  165         certain health insurance policies and certain group,
  166         blanket, or franchise health insurance policies,
  167         respectively, from requiring or incentivizing an
  168         insured to receive services from an APRN-IP in place
  169         of a primary care physician; amending s. 627.6699,
  170         F.S.; prohibiting certain health benefit plans from
  171         requiring or incentivizing an insured to receive
  172         services from an APRN-IP in place of a primary care
  173         physician; amending s. 627.736, F.S.; requiring
  174         personal injury protection insurance policies to cover
  175         a certain percentage of medical services and care
  176         provided by an APRN-IP; providing for specified
  177         reimbursement of APRN-IPs; amending s. 633.412, F.S.;
  178         authorizing an APRN-IP to medically examine an
  179         applicant for firefighter certification; creating s.
  180         641.31075, F.S.; prohibiting certain health
  181         maintenance contracts from requiring or incentivizing
  182         a subscriber to receive services from an APRN-IP in
  183         place of a primary care physician; amending s.
  184         641.495, F.S.; requiring certain health maintenance
  185         organization documents to disclose specified
  186         information; amending s. 744.3675, F.S.; authorizing
  187         an APRN-IP to provide the medical report of a ward in
  188         an annual guardianship plan; amending s. 766.118,
  189         F.S.; revising the definition of the term
  190         “practitioner”; amending s. 768.135, F.S.; providing
  191         immunity from liability for an APRN-IP who provides
  192         volunteer services, under certain circumstances;
  193         amending s. 960.28, F.S.; conforming a cross
  194         reference; providing appropriations; providing
  195         effective dates.
  196          
  197  Be It Enacted by the Legislature of the State of Florida:
  198  
  199         Section 1. Paragraph (v) is added to subsection (1) of
  200  section 400.141, Florida Statutes, to read:
  201         400.141 Administration and management of nursing home
  202  facilities.—
  203         (1) Every licensed facility shall comply with all
  204  applicable standards and rules of the agency and shall:
  205         (v) Be allowed to use paid feeding assistants as defined in
  206  42 C.F.R. s. 488.301, and in accordance with 42 C.F.R. s.
  207  483.60, if the paid feeding assistant has successfully completed
  208  a feeding assistant training program developed by the agency.
  209         1.The feeding assistant training program must consist of a
  210  minimum of 12 hours of education and training and must include
  211  all of the topics and lessons specified in the program
  212  curriculum.
  213         2. The program curriculum must include, but need not be
  214  limited to, training in all of the following content areas:
  215         a.Feeding techniques.
  216         b.Assistance with feeding and hydration.
  217         c.Communication and interpersonal skills.
  218         d.Appropriate responses to resident behavior.
  219         e.Safety and emergency procedures, including the first aid
  220  procedure used to treat upper airway obstructions.
  221         f.Infection control.
  222         g.Residents’ rights.
  223         h.Recognizing changes in residents which are inconsistent
  224  with their normal behavior and the importance of reporting those
  225  changes to the supervisory nurse.
  226  
  227  The agency may adopt rules to implement this paragraph.
  228         Section 2. Paragraph (b) of subsection (3) of section
  229  400.23, Florida Statutes, is amended to read:
  230         400.23 Rules; evaluation and deficiencies; licensure
  231  status.—
  232         (3)
  233         (b) Paid feeding assistants and nonnursing staff providing
  234  eating assistance to residents shall not count toward compliance
  235  with minimum staffing standards.
  236         Section 3. Subsection (1) of section 400.461, Florida
  237  Statutes, is amended to read:
  238         400.461 Short title; purpose.—
  239         (1) This part, consisting of ss. 400.461-400.52 ss.
  240  400.461-400.518, may be cited as the “Home Health Services Act.”
  241         Section 4. Subsection (15) of section 400.462, Florida
  242  Statutes, is amended to read:
  243         400.462 Definitions.—As used in this part, the term:
  244         (15) “Home health aide” means a person who is trained or
  245  qualified, as provided by rule, and who provides hands-on
  246  personal care, performs simple procedures as an extension of
  247  therapy or nursing services, assists in ambulation or exercises,
  248  or assists in administering medications as permitted in rule and
  249  for which the person has received training established by the
  250  agency under this part, or performs tasks delegated to him or
  251  her under chapter 464 s. 400.497(1).
  252         Section 5. Present subsections (5) and (6) of section
  253  400.464, Florida Statutes, are redesignated as subsections (6)
  254  and (7), respectively, a new subsection (5) is added to that
  255  section, and present subsection (6) of that section is amended,
  256  to read:
  257         400.464 Home health agencies to be licensed; expiration of
  258  license; exemptions; unlawful acts; penalties.—
  259         (5) If a licensed home health agency authorizes a
  260  registered nurse to delegate tasks, including medication
  261  administration, to a certified nursing assistant pursuant to
  262  chapter 464 or to a home health aide pursuant to s. 400.490, the
  263  licensed home health agency must ensure that such delegation
  264  meets the requirements of this chapter and chapter 464 and the
  265  rules adopted thereunder.
  266         (7)(6) Any person, entity, or organization providing home
  267  health services which is exempt from licensure under subsection
  268  (6) subsection (5) may voluntarily apply for a certificate of
  269  exemption from licensure under its exempt status with the agency
  270  on a form that specifies its name or names and addresses, a
  271  statement of the reasons why it is exempt from licensure as a
  272  home health agency, and other information deemed necessary by
  273  the agency. A certificate of exemption is valid for a period of
  274  not more than 2 years and is not transferable. The agency may
  275  charge an applicant $100 for a certificate of exemption or
  276  charge the actual cost of processing the certificate.
  277         Section 6. Subsections (2) and (3) of section 400.488,
  278  Florida Statutes, are amended to read:
  279         400.488 Assistance with self-administration of medication.—
  280         (2) Patients who are capable of self-administering their
  281  own medications without assistance shall be encouraged and
  282  allowed to do so. However, an unlicensed person may, consistent
  283  with a dispensed prescription’s label or the package directions
  284  of an over-the-counter medication, assist a patient whose
  285  condition is medically stable with the self-administration of
  286  routine, regularly scheduled medications that are intended to be
  287  self-administered. Assistance with self-medication by an
  288  unlicensed person may occur only upon a documented request by,
  289  and the written informed consent of, a patient or the patient’s
  290  surrogate, guardian, or attorney in fact. For purposes of this
  291  section, self-administered medications include both legend and
  292  over-the-counter oral dosage forms, topical dosage forms, and
  293  topical ophthalmic, otic, and nasal dosage forms, including
  294  solutions, suspensions, sprays, and inhalers, intermittent
  295  positive pressure breathing treatments, and nebulizer
  296  treatments.
  297         (3) Assistance with self-administration of medication
  298  includes:
  299         (a) Taking the medication, in its previously dispensed,
  300  properly labeled container, from where it is stored and bringing
  301  it to the patient.
  302         (b) In the presence of the patient, confirming that the
  303  medication is intended for that patient, orally advising the
  304  patient of the medication name and purpose reading the label,
  305  opening the container, removing a prescribed amount of
  306  medication from the container, and closing the container.
  307         (c) Placing an oral dosage in the patient’s hand or placing
  308  the dosage in another container and helping the patient by
  309  lifting the container to his or her mouth.
  310         (d) Applying topical medications, including providing
  311  routine preventive skin care and basic wound care.
  312         (e) Returning the medication container to proper storage.
  313         (f) For intermittent positive pressure breathing treatments
  314  or for nebulizer treatments, assisting with setting up and
  315  cleaning the device in the presence of the patient, confirming
  316  that the medication is intended for that patient, orally
  317  advising the patient of the medication name and purpose, opening
  318  the container, removing the prescribed amount for a single
  319  treatment dose from a properly labeled container, and assisting
  320  the patient with placing the dose into the medicine receptacle
  321  or mouthpiece.
  322         (g)(f) Keeping a record of when a patient receives
  323  assistance with self-administration under this section.
  324         Section 7. Section 400.489, Florida Statutes, is created to
  325  read:
  326         400.489 Administration of medication by a home health aide;
  327  staff training requirements.—
  328         (1) A home health aide may administer oral, transdermal,
  329  ophthalmic, otic, rectal, inhaled, enteral, or topical
  330  prescription medications if the home health aide has been
  331  delegated such task by a registered nurse licensed under chapter
  332  464; has satisfactorily completed an initial 6-hour training
  333  course approved by the agency; and has been found competent to
  334  administer medication to a patient in a safe and sanitary
  335  manner. The training, determination of competency, and initial
  336  and annual validations required in this section shall be
  337  conducted by a registered nurse licensed under chapter 464 or a
  338  physician licensed under chapter 458 or chapter 459.
  339         (2) A home health aide must annually and satisfactorily
  340  complete a 2-hour inservice training course approved by the
  341  agency in medication administration and medication error
  342  prevention. The inservice training course shall be in addition
  343  to the annual inservice training hours required by agency rules.
  344         (3) The agency, in consultation with the Board of Nursing,
  345  shall establish by rule standards and procedures that a home
  346  health aide must follow when administering medication to a
  347  patient. Such rules must, at a minimum, address qualification
  348  requirements for trainers, requirements for labeling medication,
  349  documentation and recordkeeping, the storage and disposal of
  350  medication, instructions concerning the safe administration of
  351  medication, informed-consent requirements and records, and the
  352  training curriculum and validation procedures.
  353         Section 8. Section 400.490, Florida Statutes, is created to
  354  read:
  355         400.490 Nurse-delegated tasks.—A certified nursing
  356  assistant or home health aide may perform any task delegated by
  357  a registered nurse as authorized in this part and in chapter
  358  464, including, but not limited to, medication administration.
  359         Section 9. Section 400.52, Florida Statutes, is created to
  360  read:
  361         400.52 Excellence in Home Health Program.—
  362         (1) There is created within the agency the Excellence in
  363  Home Health Program for the purpose of awarding program
  364  designations to home health agencies or nurse registries that
  365  meet the criteria specified in this section.
  366         (2)(a) The agency shall adopt rules establishing criteria
  367  for the program which must include, at a minimum, meeting
  368  standards relating to:
  369         1. Patient satisfaction.
  370         2. Patients requiring emergency care for wound infections.
  371         3. Patients admitted or readmitted to an acute care
  372  hospital.
  373         4. Patient improvement in the activities of daily living.
  374         5. Employee satisfaction.
  375         6. Quality of employee training.
  376         7. Employee retention rates.
  377         (b) The agency shall annually evaluate home health agencies
  378  and nurse registries seeking the program designation which apply
  379  on a form and in the manner designated by rule.
  380         (3) To receive a program designation, the home health
  381  agency or nurse registry must:
  382         (a) Be actively licensed and have been operating for at
  383  least 24 months before applying for the program designation. A
  384  designation awarded under the program is not transferable to
  385  another licensee, unless the existing home health agency or
  386  nurse registry is being relicensed in the name of an entity
  387  related to the current licenseholder by common control or
  388  ownership and there will be no change in the management,
  389  operation, or programs of the home health agency or nurse
  390  registry as a result of the relicensure.
  391         (b) Have not had any licensure denials, revocations, or
  392  class I, class II, or uncorrected class III deficiencies within
  393  the 24 months before the application for the program
  394  designation.
  395         (4) The program designation expires on the same date as the
  396  home health agency’s or nurse registry’s license. A home health
  397  agency or nurse registry must reapply and be approved biennially
  398  for the program designation to continue using the program
  399  designation in the manner authorized under subsection (5).
  400         (5) A home health agency or nurse registry that is awarded
  401  a designation under the program may use the designation in
  402  advertising and marketing, unless the home health agency or
  403  nurse registry:
  404         (a) Has not been awarded the designation;
  405         (b) Fails to renew the designation upon expiration of the
  406  awarded designation;
  407         (c) Has undergone a change in ownership that does not
  408  qualify for an exception under paragraph (3)(a); or
  409         (d) Has been notified that it no longer meets the criteria
  410  for the award upon reapplication after expiration of the awarded
  411  designation.
  412         (6)An application for an award designation under the
  413  program is not an application for licensure. A designation award
  414  or denial by the agency under this section does not constitute
  415  final agency action subject to chapter 120.
  416         Section 10. Section 408.822, Florida Statutes, is created
  417  to read:
  418         408.822 Direct care workforce survey.—
  419         (1) For purposes of this section, the term “direct care
  420  worker” means a certified nursing assistant, a home health aide,
  421  a personal care assistant, a companion services or homemaker
  422  services provider, a paid feeding assistant trained under s.
  423  400.141(1)(v), or another individual who provides personal care
  424  as defined in s. 400.462 to individuals who are elderly,
  425  developmentally disabled, or chronically ill.
  426         (2) Beginning January 1, 2021, each licensee that applies
  427  for licensure renewal as a nursing home facility licensed under
  428  part II of chapter 400, an assisted living facility licensed
  429  under part I of chapter 429, or a home health agency or
  430  companion services or homemaker services provider licensed under
  431  part III of chapter 400 shall furnish all of the following
  432  information to the agency in a survey on the direct care
  433  workforce:
  434         (a) The number of registered nurses and the number of
  435  direct care workers by category employed by the licensee.
  436         (b) The turnover and vacancy rates of registered nurses and
  437  direct care workers and the contributing factors to these rates.
  438         (c) The average employee wage for registered nurses and
  439  each category of direct care worker.
  440         (d) Employment benefits for registered nurses and direct
  441  care workers and the average cost of such benefits to the
  442  employer and the employee.
  443         (e) Type and availability of training for registered nurses
  444  and direct care workers.
  445         (3) An administrator or designee shall include the
  446  information required in subsection (2) on a survey form
  447  developed by the agency by rule which must contain an
  448  attestation that the information provided is true and accurate
  449  to the best of his or her knowledge.
  450         (4) The licensee must submit the completed survey before
  451  the agency issues the license renewal.
  452         (5) The agency shall continually analyze the results of the
  453  surveys and publish the results on its website. The agency shall
  454  update the information published on its website monthly.
  455         Section 11. Section 464.0156, Florida Statutes, is created
  456  to read:
  457         464.0156 Delegation of duties.—
  458         (1) A registered nurse may delegate a task to a certified
  459  nursing assistant certified under part II of this chapter or a
  460  home health aide as defined in s. 400.462 if the registered
  461  nurse determines that the certified nursing assistant or the
  462  home health aide is competent to perform the task, the task is
  463  delegable under federal law, and the task meets all of the
  464  following criteria:
  465         (a) Is within the nurse’s scope of practice.
  466         (b) Frequently recurs in the routine care of a patient or
  467  group of patients.
  468         (c) Is performed according to an established sequence of
  469  steps.
  470         (d) Involves little or no modification from one patient to
  471  another.
  472         (e) May be performed with a predictable outcome.
  473         (f) Does not inherently involve ongoing assessment,
  474  interpretation, or clinical judgment.
  475         (g) Does not endanger a patient’s life or well-being.
  476         (2) A registered nurse may delegate to a certified nursing
  477  assistant or a home health aide the administration of oral,
  478  transdermal, ophthalmic, otic, rectal, inhaled, enteral, or
  479  topical prescription medications to a patient of a home health
  480  agency, if the certified nursing assistant or home health aide
  481  meets the requirements of s. 464.2035 or s. 400.489,
  482  respectively. A registered nurse may not delegate the
  483  administration of any controlled substance listed in Schedule
  484  II, Schedule III, or Schedule IV of s. 893.03 or 21 U.S.C. s.
  485  812.
  486         (3) The board, in consultation with the Agency for Health
  487  Care Administration, shall adopt rules to implement this
  488  section.
  489         Section 12. Paragraph (r) is added to subsection (1) of
  490  section 464.018, Florida Statutes, to read:
  491         464.018 Disciplinary actions.—
  492         (1) The following acts constitute grounds for denial of a
  493  license or disciplinary action, as specified in ss. 456.072(2)
  494  and 464.0095:
  495         (r) Delegating professional responsibilities to a person
  496  when the nurse delegating such responsibilities knows or has
  497  reason to know that such person is not qualified by training,
  498  experience, certification, or licensure to perform them.
  499         Section 13. Section 464.2035, Florida Statutes, is created
  500  to read:
  501         464.2035 Administration of medication.—
  502         (1) A certified nursing assistant may administer oral,
  503  transdermal, ophthalmic, otic, rectal, inhaled, enteral, or
  504  topical prescription medication to a patient of a home health
  505  agency if the certified nursing assistant has been delegated
  506  such task by a registered nurse licensed under part I of this
  507  chapter, has satisfactorily completed an initial 6-hour training
  508  course approved by the board, and has been found competent to
  509  administer medication to a patient in a safe and sanitary
  510  manner. The training, determination of competency, and initial
  511  and annual validation required under this section must be
  512  conducted by a registered nurse licensed under this chapter or a
  513  physician licensed under chapter 458 or chapter 459.
  514         (2) A certified nursing assistant shall annually and
  515  satisfactorily complete 2 hours of inservice training in
  516  medication administration and medication error prevention
  517  approved by the board, in consultation with the Agency for
  518  Health Care Administration. The inservice training is in
  519  addition to the other annual inservice training hours required
  520  under this part.
  521         (3) The board, in consultation with the Agency for Health
  522  Care Administration, shall establish by rule standards and
  523  procedures that a certified nursing assistant must follow when
  524  administering medication to a patient of a home health agency.
  525  Such rules must, at a minimum, address qualification
  526  requirements for trainers, requirements for labeling medication,
  527  documentation and recordkeeping, the storage and disposal of
  528  medication, instructions concerning the safe administration of
  529  medication, informed-consent requirements and records, and the
  530  training curriculum and validation procedures.
  531         Section 14. Effective July 1, 2020, section 381.40185,
  532  Florida Statutes, is created to read:
  533         381.40185Physician Student Loan Repayment Program.—The
  534  Physician Student Loan Repayment Program is established to
  535  promote access to primary care by supporting qualified
  536  physicians who treat medically underserved populations in
  537  primary care health professional shortage areas or medically
  538  underserved areas.
  539         (1) As used in this section, the term:
  540         (a) “Department” means the Department of Health.
  541         (b) “Loan program” means the Physician Student Loan
  542  Repayment Program.
  543         (c) “Medically underserved area” means a geographic area
  544  designated as such by the Health Resources and Services
  545  Administration of the United States Department of Health and
  546  Human Services.
  547         (d) “Primary care health professional shortage area” means
  548  a geographic area, an area having a special population, or a
  549  facility that is designated by the Health Resources and Services
  550  Administration of the United States Department of Health and
  551  Human Services as a health professional shortage area as defined
  552  by federal regulation and that has a shortage of primary care
  553  professionals who serve Medicaid recipients and other low-income
  554  patients.
  555         (e) “Public health program” means a county health
  556  department, the Children’s Medical Services program, a federally
  557  funded community health center, a federally funded migrant
  558  health center, or any other publicly funded or nonprofit health
  559  care program designated by the department.
  560         (2) The department shall establish a physician student loan
  561  repayment program to benefit physicians licensed under chapter
  562  458 or chapter 459 who demonstrate, as required by department
  563  rule, active employment providing primary care services in a
  564  public health program, an independent practice, or a group
  565  practice that serves Medicaid recipients and other low-income
  566  patients and that is located in a primary care health
  567  professional shortage area or in a medically underserved area.
  568         (3) The department shall award funds from the loan program
  569  to repay the student loans of a physician who meets the
  570  requirements of subsection (2).
  571         (a) An award may not exceed $50,000 per year per eligible
  572  physician.
  573         (b) Only loans to pay the costs of tuition, books, medical
  574  equipment and supplies, uniforms, and living expenses may be
  575  covered.
  576         (c) All repayments are contingent upon continued proof of
  577  eligibility and must be made directly to the holder of the loan.
  578  The state bears no responsibility for the collection of any
  579  interest charges or other remaining balances.
  580         (d) A physician may receive funds under the loan program
  581  for at least 1 year, up to a maximum of 5 years.
  582         (e) The department may only grant up to 10 new awards per
  583  fiscal year and shall limit the total number of physicians
  584  participating in the loan program to not more than 50 per fiscal
  585  year.
  586         (4) A physician is no longer eligible to receive funds
  587  under the loan program if the physician:
  588         (a) Is no longer employed as required under subsection (2);
  589         (b) Ceases to participate in the Florida Medicaid program;
  590  or
  591         (c) Has disciplinary action taken against his or her
  592  license by the Board of Medicine for a violation of s. 458.331
  593  or by the Board of Osteopathic Medicine for a violation of s.
  594  459.015.
  595         (5) The department shall adopt rules to implement the loan
  596  program.
  597         (6) Implementation of the loan program is subject to
  598  legislative appropriation.
  599         Section 15. Effective July 1, 2020, present subsections (4)
  600  through (21) of section 464.003, Florida Statutes, are
  601  redesignated as subsections (5) through (22), respectively, and
  602  a new subsection (4) is added to that section, to read:
  603         464.003 Definitions.—As used in this part, the term:
  604         (4) “Advanced practice registered nurse - independent
  605  practitioner” or “APRN-IP” means an advanced practice registered
  606  nurse who is registered under s. 464.0123 to provide primary
  607  health care services without a protocol agreement or
  608  supervision.
  609         Section 16. Effective July 1, 2020, section 464.0123,
  610  Florida Statutes, is created to read:
  611         464.0123 Patient Access to Primary Care Program.—
  612         (1) PROGRAM PURPOSE.—The Patient Access to Primary Care
  613  Program is created for the purpose of providing primary health
  614  care services in primary care health professional shortage
  615  areas. The department shall implement this program.
  616         (2) DEFINITIONS.—As used in this section, the term:
  617         (a) “Council” means the Council on Advanced Practice
  618  Registered Nurse Independent Practice established in subsection
  619  (3).
  620         (b) “Physician” means a person licensed under chapter 458
  621  to practice medicine or a person licensed under chapter 459 to
  622  practice osteopathic medicine.
  623         (c) “Primary care health professional shortage area” means
  624  a geographic area, an area having a special population, or a
  625  facility with a score of at least 18, as designated and
  626  calculated by the Federal Health Resources and Services
  627  Administration or a rural area as defined by the Federal Office
  628  of Rural Health Policy.
  629         (3)COUNCIL ON ADVANCED PRACTICE REGISTERED NURSE
  630  INDEPENDENT PRACTICE.—
  631         (a) The Council on Advanced Practice Registered Nurse
  632  Independent Practice is created within the department.
  633         (b) The council shall consist of the following nine
  634  members:
  635         1. Two members appointed by the chair of the Board of
  636  Medicine who are physicians and members of the Board of
  637  Medicine.
  638         2. Two members appointed by the chair of the Board of
  639  Osteopathic Medicine who are physicians and members of the Board
  640  of Osteopathic Medicine.
  641         3. Four members appointed by the chair of the Board of
  642  Nursing who are advanced practice registered nurses and who have
  643  each completed at least 10,000 hours of supervised practice over
  644  a period of at least 5 years under a protocol with a supervising
  645  physician.
  646         4. The State Surgeon General or his or her designee.
  647         (c) The Board of Medicine members, the Board of Osteopathic
  648  Medicine members, and the Board of Nursing appointee members
  649  shall be appointed for terms of 4 years. The initial
  650  appointments shall be staggered so that one member from the
  651  Board of Medicine, one member from the Board of Osteopathic
  652  Medicine, and one appointee member from the Board of Nursing
  653  shall each be appointed for a term of 4 years; one member from
  654  the Board of Medicine and one appointee member from the Board of
  655  Nursing shall each be appointed for a term of 3 years; and one
  656  member from the Board of Osteopathic Medicine and two appointee
  657  members from the Board of Nursing shall each be appointed for a
  658  term of 2 years. Initial physician members appointed to the
  659  council must be physicians who have practiced with advanced
  660  practice registered nurses under a protocol in their practice.
  661         (d) Council members may not serve more than two consecutive
  662  terms. The council shall annually elect a chair from among its
  663  members.
  664         (e)All recommendations made by the council must be made by
  665  a majority of members present.
  666         (f) The council shall:
  667         1. Review applications for and recommend to the department
  668  the registration of APRN-IPs.
  669         2. Develop proposed rules regulating the practice of APRN
  670  IPs. The council shall also develop proposed rules to ensure
  671  that the continuity of practice of APRN-IPs is maintained in
  672  primary care health professional shortage areas. The language of
  673  proposed rules developed by the council must be submitted to the
  674  department. Based on the council′s proposed rules, the
  675  department shall adopt rules regulating the practice of APRN
  676  IPs.
  677         3. Make recommendations to the department regarding all
  678  matters relating to APRN-IPs.
  679         4. Address concerns and problems of APRN-IPs in order to
  680  improve safety in the clinical practices of APRN-IPs.
  681         (g) When the council finds that an applicant for licensure
  682  has failed to meet, to the council’s satisfaction, each of the
  683  requirements for registration set forth in this section, the
  684  council may enter an order to:
  685         1. Refuse to register the applicant;
  686         2. Approve the applicant for registration with restrictions
  687  on the scope of practice or registration; or
  688         3. Approve the applicant for limited registration with
  689  conditions. Such conditions may include placement of the
  690  registrant on probation for a period of time and subject to such
  691  conditions as the council may specify, including, but not
  692  limited to, requiring the registrant to undergo treatment, to
  693  attend continuing education courses, to work under the direct
  694  supervision of a physician licensed in this state, or to take
  695  corrective action, as determined by the council.
  696         (4) REGISTRATION.—To be registered as an APRN-IP, an
  697  advanced practice registered nurse must apply to the department
  698  on forms developed by the department. The council shall review
  699  the application and recommend to the department the registration
  700  of the advanced practice registered nurse with the Board of
  701  Medicine as an APRN-IP if the applicant submits proof that he or
  702  she holds an unrestricted license issued under s. 464.012 and
  703  provides all of the following information:
  704         (a) The name of each location at which the applicant has
  705  practiced as an advanced practice registered nurse pursuant to
  706  an established written protocol under the direct or indirect
  707  supervision of a physician for 2,000 hours within the last 4
  708  years and the names and addresses of all supervising physicians
  709  during that period.
  710         (b) Any certification or designation that the applicant has
  711  received from a specialty or certification board which is
  712  recognized or approved by the Board of Nursing, the Board of
  713  Medicine, the Board of Osteopathic Medicine, or the department.
  714         (c) The calendar years in which the applicant:
  715         1. Received his or her initial advanced practice registered
  716  nurse certification, licensure, or registration;
  717         2. Began practicing in any jurisdiction; and
  718         3. Received initial advanced practice registered nurse
  719  licensure in this state.
  720         (d) The address at which the applicant will primarily
  721  conduct his or her practice, if known.
  722         (e) The name of each school or training program that the
  723  applicant has attended, with the months and years of attendance
  724  and the month and year of graduation, and a description of all
  725  graduate professional education completed by the applicant,
  726  excluding any coursework taken to satisfy continuing education
  727  requirements.
  728         (f) Any appointment to the faculty of a school related to
  729  the profession which the applicant currently holds or has held
  730  within the past 10 years and an indication as to whether the
  731  applicant has been responsible for graduate education within the
  732  past 10 years.
  733         (g) A description of any criminal offense of which the
  734  applicant has been found guilty, regardless of whether
  735  adjudication of guilt was withheld, or to which the applicant
  736  has pled guilty or nolo contendere. A criminal offense committed
  737  in another jurisdiction which would have been a felony or
  738  misdemeanor if committed in this state must be reported. If the
  739  applicant indicates to the department that a criminal offense is
  740  under appeal and submits a copy of the notice for appeal of that
  741  criminal offense, the department must state that the criminal
  742  offense is under appeal if the criminal offense is reported in
  743  the applicant’s profile. If the applicant indicates to the
  744  department that a criminal offense is under appeal, the
  745  applicant must, within 15 days after the disposition of the
  746  appeal, submit to the department a copy of the final written
  747  order of disposition.
  748         (h) A description of any disciplinary action as specified
  749  in s. 456.077, s. 458.320, or s. 464.018 or any similar
  750  disciplinary action in any other jurisdiction of the United
  751  States by a licensing or regulatory body; by a specialty board
  752  that is recognized by the Board of Nursing, the Board of
  753  Medicine, the Board of Osteopathic Medicine, or the department;
  754  or by a licensed hospital, health maintenance organization,
  755  prepaid health clinic, ambulatory surgical center, or nursing
  756  home. Disciplinary action includes resignation from or
  757  nonrenewal of staff membership or the restriction of privileges
  758  at a licensed hospital, health maintenance organization, prepaid
  759  health clinic, ambulatory surgical center, or nursing home taken
  760  in lieu of or in settlement of a pending disciplinary case
  761  related to competence or character. If the applicant indicates
  762  to the department that a disciplinary action is under appeal and
  763  submits a copy of the document initiating an appeal of the
  764  disciplinary action, the department must state that the
  765  disciplinary action is under appeal if the disciplinary action
  766  is reported in the applicant’s profile. If the applicant
  767  indicates to the department that a disciplinary action is under
  768  appeal, the applicant must, within 15 days after the disposition
  769  of the appeal, submit to the department a copy of the final
  770  written order of disposition.
  771         (i)1. Proof that he or she has obtained or will be
  772  obtaining and will maintain professional liability insurance
  773  coverage in an amount not less than $100,000 per claim, with a
  774  minimum annual aggregate of not less than $300,000, from an
  775  authorized insurer as defined in s. 624.09, from one of the
  776  following:
  777         a. An eligible surplus lines insurer as defined in s.
  778  626.914(2);
  779         b. A risk retention group as defined in s. 627.942, from
  780  the Joint Underwriting Association established under s.
  781  627.351(4); or
  782         c. A plan of self-insurance as provided in s. 627.357; or
  783         2. Proof that he or she has obtained and will be
  784  maintaining an unexpired, irrevocable letter of credit,
  785  established pursuant to chapter 675, in an amount of not less
  786  than $100,000 per claim, with a minimum aggregate availability
  787  of credit of not less than $300,000. The letter of credit must
  788  be payable to the APRN-IP as beneficiary upon presentment of a
  789  final judgment indicating liability and awarding damages to be
  790  paid by the APRN-IP or upon presentment of a settlement
  791  agreement signed by all parties to such agreement when such
  792  final judgment or settlement is a result of a claim arising out
  793  of the rendering of, or the failure to render, medical or
  794  nursing care and services while practicing as an APRN-IP.
  795         (j) Documentation of completion within the last 5 years of
  796  three graduate-level semester hours, or the equivalent, in
  797  differential diagnosis and three graduate-level semester hours,
  798  or the equivalent, in pharmacology, and any additional
  799  coursework as recommended by the council. Such hours may not be
  800  continuing education courses.
  801         (k) Any additional information that the council may require
  802  from the applicant, as determined by the council.
  803         (5) REGISTRATION RENEWAL.—An APRN-IP may seek renewal of
  804  his or her registration biennially by applying to the department
  805  on forms developed by the department.
  806         (a) An APRN-IP seeking registration renewal must provide
  807  documentation proving his or her completion of a minimum of 40
  808  continuing medical education hours. The required continuing
  809  medical education hours must include 3 hours on the safe and
  810  effective prescribing of controlled substances; 2 hours on human
  811  trafficking; 2 hours on the prevention of medical errors; 2
  812  hours on domestic violence; and 2 hours on suicide prevention,
  813  which must address suicide risk assessment, treatment, and
  814  management, if such topics are not required for licensure under
  815  this part.
  816         (b) The continuing medical education hours required under
  817  paragraph (a):
  818         1. Must be obtained in courses approved by the Board of
  819  Medicine or the Board of Osteopathic Medicine and offered by a
  820  statewide professional association of physicians or osteopathic
  821  physicians in this state which is accredited to provide
  822  educational activities designated for the American Medical
  823  Association Physician’s Recognition Award Category 1 credit or
  824  the American Osteopathic Category 1-A continuing medical
  825  education credit.
  826         2.May be counted toward the required continuing education
  827  hours, including required subject area hours, for an APRN-IP’s
  828  renewal of his or her APRN or RN license, as provided under
  829  board rule.
  830         (6) PRACTITIONER PROFILE.—Upon issuing a registration or a
  831  renewal of registration, the department shall update the
  832  practitioner’s profile, as described in s. 456.041, to reflect
  833  that the advanced practice registered nurse is registered as an
  834  APRN-IP.
  835         (7) APRN-IP SCOPE OF PRACTICE.—An APRN-IP may provide
  836  primary health care services without a protocol agreement or
  837  supervision only in primary care health professional shortage
  838  areas during the first 3 years of his or her independent
  839  practice without such agreement or supervision. After 3 years of
  840  such independent practice in a primary care health professional
  841  shortage area, an APRN-IP may practice independently for the
  842  provision of primary health care services in any area of the
  843  state. For the purposes of this subsection, “3 years of such
  844  independent practice” means an APRN-IP has established an
  845  independent practice in a primary care health professional
  846  shortage area under this section which serves as his or her
  847  primary professional practice and has actively provided primary
  848  health care services to patients under that practice for 3 full
  849  years.
  850         (a) An APRN-IP may not practice in a hospital licensed
  851  under chapter 395 or in a facility licensed under chapter 400,
  852  except under an established written protocol with a supervising
  853  physician which is maintained at the hospital or facility.
  854         (b) The department shall adopt by rule the scope of
  855  practice for an APRN-IP. Such rules must address, but are not
  856  limited to, all of the following topics:
  857         1. The scope of the medical care, treatment, and services
  858  an APRN-IP may provide to patients.
  859         2.Medical care, treatment, and services that are outside
  860  the scope of the practice of an APRN-IP.
  861         3.Patient populations to which an APRN-IP may provide
  862  primary care, treatment, and services.
  863         4.Patient populations to which an APRN-IP may not provide
  864  primary care, treatment, or services.
  865         5. Patient populations that the APRN-IP must refer to a
  866  physician.
  867         6. Guidelines for prescribing controlled substances for the
  868  treatment of chronic nonmalignant pain and acute pain, including
  869  evaluation of the patient, creation and maintenance of a
  870  treatment plan, obtaining informed consent and agreement for
  871  treatment, periodic review of the treatment plan, consultation,
  872  medical record review, and compliance with controlled substance
  873  laws and regulations.
  874         7.Information regarding the credentials of the APRN-IP
  875  which must be disclosed to patients in a written informed
  876  consent to care and treatment, including, but not limited to,
  877  notification to the patient that the APRN-IP is not a physician
  878  and may not be referred to as a “doctor” or a “physician” in a
  879  medical setting.
  880         8.Requirements relating to the APRN-IP practice’s
  881  recordkeeping, record retention, and availability of records for
  882  inspection by the department.
  883         9. Advertising restrictions and disclosure requirements for
  884  APRN-IPs, including that the APRN-IP may not be referred to as a
  885  “doctor” or a “physician” in a medical setting.
  886         (8) REPORTS OF ADVERSE INCIDENTS BY APRN-IPs.—
  887         (a) Any APRN-IP practicing in this state must notify the
  888  department if he or she was involved in an adverse incident.
  889         (b) The required notification to the department must be
  890  submitted in writing by certified mail and postmarked within 15
  891  days after the occurrence of the adverse incident.
  892         (c) For purposes of notifying the department under this
  893  section, the term “adverse incident” means an event over which
  894  the APRN-IP could exercise control and which is associated in
  895  whole or in part with a medical intervention, rather than the
  896  condition for which such intervention occurred, and which
  897  results in any of the following patient injuries:
  898         1. The death of a patient.
  899         2. An injury to the patient that is likely to be permanent.
  900         3. Any condition that required the transfer of a patient
  901  from the APRN-IP’s practice location to a hospital licensed
  902  under chapter 395.
  903         (d) The department shall review each incident and determine
  904  whether it potentially involved conduct by the APRN-IP which is
  905  grounds for disciplinary action, in which case s. 456.073
  906  applies. Disciplinary action, if any, shall be taken by the
  907  Board of Medicine or the Board of Nursing, depending on the
  908  conduct involved, as determined by the department.
  909         (e) The department shall adopt rules to implement this
  910  subsection.
  911         (9)INACTIVE AND DELINQUENT STATUS.—An APRN-IP registration
  912  that is in an inactive or delinquent status may be reactivated
  913  only as provided in s. 456.036.
  914         (10) CONSTRUCTION.—This section may not be construed to
  915  prevent third-party payors from reimbursing an APRN-IP for
  916  covered services rendered by the registered APRN-IP.
  917         (11) RULEMAKING.—The department shall adopt rules to
  918  implement this section.
  919         Section 17. Effective July 1, 2020, present subsections (9)
  920  and (10) of section 464.015, Florida Statutes, are redesignated
  921  as subsections (10) and (11), respectively, a new subsection (9)
  922  is added to that section, present subsection (9) of that section
  923  is amended, and present subsection (10) of that section is
  924  republished, to read:
  925         464.015 Titles and abbreviations; restrictions; penalty.—
  926         (9)Only persons who hold valid registrations to practice
  927  as APRN-IPs in this state may use the title “advanced practice
  928  registered nurse - independent practitioner” and the
  929  abbreviation “A.P.R.N.-I.P.” A health care practitioner or
  930  personnel within a health care facility may not refer to an
  931  APRN-IP as a “doctor” or a “physician” in a medical setting.
  932         (10)(9) A person may not practice or advertise as, or
  933  assume the title of, registered nurse, licensed practical nurse,
  934  clinical nurse specialist, certified registered nurse
  935  anesthetist, certified nurse midwife, certified nurse
  936  practitioner, or advanced practice registered nurse, or advanced
  937  practice registered nurse - independent practitioner; use the
  938  abbreviation “R.N.,” “L.P.N.,” “C.N.S.,” “C.R.N.A.,” “C.N.M.,”
  939  “C.N.P.,” or “A.P.R.N.,or “A.P.R.N.-I.P.”; or take any other
  940  action that would lead the public to believe that person was
  941  authorized by law to practice as such or is performing nursing
  942  services pursuant to the exception set forth in s. 464.022(8)
  943  unless that person is licensed, certified, or authorized
  944  pursuant to s. 464.0095 to practice as such.
  945         (11)(10) A violation of this section is a misdemeanor of
  946  the first degree, punishable as provided in s. 775.082 or s.
  947  775.083.
  948         Section 18. Effective July 1, 2020, paragraph (s) is added
  949  to subsection (1) of section 464.018, Florida Statutes, as
  950  amended by section 12 of this act, to read:
  951         464.018 Disciplinary actions.—
  952         (1) The following acts constitute grounds for denial of a
  953  license or disciplinary action, as specified in ss. 456.072(2)
  954  and 464.0095:
  955         (s) For an APRN-IP registered under s. 464.0123, in
  956  addition to the grounds for discipline set forth in paragraph
  957  (p) and in s. 456.072(1), any of the following are grounds for
  958  discipline:
  959         1. Paying or receiving any commission, bonus, kickback, or
  960  rebate from, or engaging in any split-fee arrangement in any
  961  form whatsoever with, a health care practitioner, an
  962  organization, an agency, or a person, either directly or
  963  implicitly, for referring patients to providers of health care
  964  goods or services, including, but not limited to, hospitals,
  965  nursing homes, clinical laboratories, ambulatory surgical
  966  centers, or pharmacies. This subparagraph may not be construed
  967  to prevent an APRN-IP from receiving a fee for professional
  968  consultation services.
  969         2. Exercising influence within a patient’s relationship
  970  with an APRN-IP for purposes of engaging a patient in sexual
  971  activity. A patient shall be presumed to be incapable of giving
  972  free, full, and informed consent to sexual activity with his or
  973  her APRN-IP.
  974         3. Making deceptive, untrue, or fraudulent representations,
  975  or employing a trick or scheme, in or related to advanced
  976  practice registered nurse independent practice.
  977         4. Soliciting patients, either personally or through an
  978  agent, by the use of fraud, intimidation, undue influence, or a
  979  form of overreaching or vexatious conduct. As used in this
  980  subparagraph, the term “soliciting” means directly or implicitly
  981  requesting an immediate oral response from the recipient.
  982         5. Failing to keep legible medical records, as defined by
  983  rules of the Board of Medicine and the Board of Osteopathic
  984  Medicine, that identify the APRN-IP, by name and professional
  985  title, who is responsible for rendering, ordering, supervising,
  986  or billing for the patient’s medically necessary care,
  987  treatment, services, diagnostic tests, or treatment procedures;
  988  and the medical justification for the patient’s course of care
  989  and treatment, including, but not limited to, patient histories,
  990  examination results, and test results; drugs prescribed,
  991  dispensed, or administered; and reports of consultations or
  992  referrals.
  993         6. Exercising influence on a patient to exploit the patient
  994  for the financial gain of the APRN-IP or a third party,
  995  including, but not limited to, the promoting or selling of
  996  services, goods, appliances, or drugs.
  997         7. Performing professional services that have not been duly
  998  authorized by the patient or his or her legal representative,
  999  except as provided in s. 766.103 or s. 768.13.
 1000         8. Performing any procedure or prescribing any medication
 1001  or therapy that would constitute experimentation on a human
 1002  subject.
 1003         9. Delegating professional responsibilities to a person
 1004  when the APRN-IP knows, or has reason to believe, that such
 1005  person is not qualified by education, training, experience, or
 1006  licensure to perform such responsibilities.
 1007         10. Committing, or conspiring with another to commit, an
 1008  act that would coerce, intimidate, or preclude another APRN-IP
 1009  from lawfully advertising his or her services.
 1010         11. Advertising or holding himself or herself out as having
 1011  a certification in a specialty which he or she has not received.
 1012         12. Failing to comply with the requirements of ss. 381.026
 1013  and 381.0261 related to providing patients with information
 1014  about their rights and how to file a complaint.
 1015         13. Providing deceptive or fraudulent expert witness
 1016  testimony related to advanced practice registered nurse
 1017  independent practice.
 1018         Section 19. Effective July 1, 2020, paragraph (c) of
 1019  subsection (2) of section 381.026, Florida Statutes, is amended
 1020  to read:
 1021         381.026 Florida Patient’s Bill of Rights and
 1022  Responsibilities.—
 1023         (2) DEFINITIONS.—As used in this section and s. 381.0261,
 1024  the term:
 1025         (c) “Health care provider” means a physician licensed under
 1026  chapter 458, an osteopathic physician licensed under chapter
 1027  459, or a podiatric physician licensed under chapter 461, or an
 1028  APRN-IP registered under s. 464.0123.
 1029         Section 20. Effective July 1, 2020, paragraph (a) of
 1030  subsection (2) and subsections (3), (4), and (5) of section
 1031  382.008, Florida Statutes, are amended to read:
 1032         382.008 Death, fetal death, and nonviable birth
 1033  registration.—
 1034         (2)(a) The funeral director who first assumes custody of a
 1035  dead body or fetus shall file the certificate of death or fetal
 1036  death. In the absence of the funeral director, the physician,
 1037  APRN-IP registered under s. 464.0123, or other person in
 1038  attendance at or after the death or the district medical
 1039  examiner of the county in which the death occurred or the body
 1040  was found shall file the certificate of death or fetal death.
 1041  The person who files the certificate shall obtain personal data
 1042  from a legally authorized person as described in s. 497.005 or
 1043  the best qualified person or source available. The medical
 1044  certification of cause of death shall be furnished to the
 1045  funeral director, either in person or via certified mail or
 1046  electronic transfer, by the physician, APRN-IP registered under
 1047  s. 464.0123, or medical examiner responsible for furnishing such
 1048  information. For fetal deaths, the physician, APRN-IP registered
 1049  under s. 464.0123, midwife, or hospital administrator shall
 1050  provide any medical or health information to the funeral
 1051  director within 72 hours after expulsion or extraction.
 1052         (3) Within 72 hours after receipt of a death or fetal death
 1053  certificate from the funeral director, the medical certification
 1054  of cause of death shall be completed and made available to the
 1055  funeral director by the decedent’s primary or attending
 1056  practitioner physician or, if s. 382.011 applies, the district
 1057  medical examiner of the county in which the death occurred or
 1058  the body was found. The primary or attending practitioner
 1059  physician or the medical examiner shall certify over his or her
 1060  signature the cause of death to the best of his or her knowledge
 1061  and belief. As used in this section, the term “primary or
 1062  attending practitioner physician” means a physician or an APRN
 1063  IP registered under s. 464.0123 who treated the decedent through
 1064  examination, medical advice, or medication during the 12 months
 1065  preceding the date of death.
 1066         (a) The department may grant the funeral director an
 1067  extension of time upon a good and sufficient showing of any of
 1068  the following conditions:
 1069         1. An autopsy is pending.
 1070         2. Toxicology, laboratory, or other diagnostic reports have
 1071  not been completed.
 1072         3. The identity of the decedent is unknown and further
 1073  investigation or identification is required.
 1074         (b) If the decedent’s primary or attending practitioner
 1075  physician or the district medical examiner of the county in
 1076  which the death occurred or the body was found indicates that he
 1077  or she will sign and complete the medical certification of cause
 1078  of death but will not be available until after the 5-day
 1079  registration deadline, the local registrar may grant an
 1080  extension of 5 days. If a further extension is required, the
 1081  funeral director must provide written justification to the
 1082  registrar.
 1083         (4) If the department or local registrar grants an
 1084  extension of time to provide the medical certification of cause
 1085  of death, the funeral director shall file a temporary
 1086  certificate of death or fetal death which shall contain all
 1087  available information, including the fact that the cause of
 1088  death is pending. The decedent’s primary or attending
 1089  practitioner physician or the district medical examiner of the
 1090  county in which the death occurred or the body was found shall
 1091  provide an estimated date for completion of the permanent
 1092  certificate.
 1093         (5) A permanent certificate of death or fetal death,
 1094  containing the cause of death and any other information that was
 1095  previously unavailable, shall be registered as a replacement for
 1096  the temporary certificate. The permanent certificate may also
 1097  include corrected information if the items being corrected are
 1098  noted on the back of the certificate and dated and signed by the
 1099  funeral director, physician, APRN-IP registered under s.
 1100  464.0123, or district medical examiner of the county in which
 1101  the death occurred or the body was found, as appropriate.
 1102         Section 21. Effective July 1, 2020, subsection (1) of
 1103  section 382.011, Florida Statutes, is amended to read:
 1104         382.011 Medical examiner determination of cause of death.—
 1105         (1) In the case of any death or fetal death due to causes
 1106  or conditions listed in s. 406.11, any death that occurred more
 1107  than 12 months after the decedent was last treated by a primary
 1108  or attending physician or an APRN-IP registered under s.
 1109  464.0123 as defined in s. 382.008(3), or any death for which
 1110  there is reason to believe that the death may have been due to
 1111  an unlawful act or neglect, the funeral director or other person
 1112  to whose attention the death may come shall refer the case to
 1113  the district medical examiner of the county in which the death
 1114  occurred or the body was found for investigation and
 1115  determination of the cause of death.
 1116         Section 22. Effective July 1, 2020, paragraphs (a) and (f)
 1117  of subsection (2) of section 394.463, Florida Statutes, are
 1118  amended to read:
 1119         394.463 Involuntary examination.—
 1120         (2) INVOLUNTARY EXAMINATION.—
 1121         (a) An involuntary examination may be initiated by any one
 1122  of the following means:
 1123         1. A circuit or county court may enter an ex parte order
 1124  stating that a person appears to meet the criteria for
 1125  involuntary examination and specifying the findings on which
 1126  that conclusion is based. The ex parte order for involuntary
 1127  examination must be based on written or oral sworn testimony
 1128  that includes specific facts that support the findings. If other
 1129  less restrictive means are not available, such as voluntary
 1130  appearance for outpatient evaluation, a law enforcement officer,
 1131  or other designated agent of the court, shall take the person
 1132  into custody and deliver him or her to an appropriate, or the
 1133  nearest, facility within the designated receiving system
 1134  pursuant to s. 394.462 for involuntary examination. The order of
 1135  the court shall be made a part of the patient’s clinical record.
 1136  A fee may not be charged for the filing of an order under this
 1137  subsection. A facility accepting the patient based on this order
 1138  must send a copy of the order to the department within 5 working
 1139  days. The order may be submitted electronically through existing
 1140  data systems, if available. The order shall be valid only until
 1141  the person is delivered to the facility or for the period
 1142  specified in the order itself, whichever comes first. If a no
 1143  time limit is not specified in the order, the order is shall be
 1144  valid for 7 days after the date that the order was signed.
 1145         2. A law enforcement officer shall take a person who
 1146  appears to meet the criteria for involuntary examination into
 1147  custody and deliver the person or have him or her delivered to
 1148  an appropriate, or the nearest, facility within the designated
 1149  receiving system pursuant to s. 394.462 for examination. The
 1150  officer shall execute a written report detailing the
 1151  circumstances under which the person was taken into custody,
 1152  which must be made a part of the patient’s clinical record. Any
 1153  facility accepting the patient based on this report must send a
 1154  copy of the report to the department within 5 working days.
 1155         3. A physician, a clinical psychologist, a psychiatric
 1156  nurse, an APRN-IP registered under s. 464.0123, a mental health
 1157  counselor, a marriage and family therapist, or a clinical social
 1158  worker may execute a certificate stating that he or she has
 1159  examined a person within the preceding 48 hours and finds that
 1160  the person appears to meet the criteria for involuntary
 1161  examination and stating the observations upon which that
 1162  conclusion is based. If other less restrictive means, such as
 1163  voluntary appearance for outpatient evaluation, are not
 1164  available, a law enforcement officer shall take into custody the
 1165  person named in the certificate and deliver him or her to the
 1166  appropriate, or nearest, facility within the designated
 1167  receiving system pursuant to s. 394.462 for involuntary
 1168  examination. The law enforcement officer shall execute a written
 1169  report detailing the circumstances under which the person was
 1170  taken into custody. The report and certificate shall be made a
 1171  part of the patient’s clinical record. Any facility accepting
 1172  the patient based on this certificate must send a copy of the
 1173  certificate to the department within 5 working days. The
 1174  document may be submitted electronically through existing data
 1175  systems, if applicable.
 1176  
 1177  When sending the order, report, or certificate to the
 1178  department, a facility shall, at a minimum, provide information
 1179  about which action was taken regarding the patient under
 1180  paragraph (g), which information shall also be made a part of
 1181  the patient’s clinical record.
 1182         (f) A patient shall be examined by a physician, an APRN-IP
 1183  registered under s. 464.0123, or a clinical psychologist, or by
 1184  a psychiatric nurse performing within the framework of an
 1185  established protocol with a psychiatrist, at a facility without
 1186  unnecessary delay to determine if the criteria for involuntary
 1187  services are met. Emergency treatment may be provided upon the
 1188  order of a physician if the physician determines that such
 1189  treatment is necessary for the safety of the patient or others.
 1190  The patient may not be released by the receiving facility or its
 1191  contractor without the documented approval of a psychiatrist or
 1192  a clinical psychologist or, if the receiving facility is owned
 1193  or operated by a hospital or health system, the release may also
 1194  be approved by a psychiatric nurse performing within the
 1195  framework of an established protocol with a psychiatrist, or an
 1196  attending emergency department physician with experience in the
 1197  diagnosis and treatment of mental illness after completion of an
 1198  involuntary examination pursuant to this subsection. A
 1199  psychiatric nurse may not approve the release of a patient if
 1200  the involuntary examination was initiated by a psychiatrist
 1201  unless the release is approved by the initiating psychiatrist.
 1202         Section 23. Effective July 1, 2020, paragraph (a) of
 1203  subsection (2) of section 397.501, Florida Statutes, is amended
 1204  to read:
 1205         397.501 Rights of individuals.—Individuals receiving
 1206  substance abuse services from any service provider are
 1207  guaranteed protection of the rights specified in this section,
 1208  unless otherwise expressly provided, and service providers must
 1209  ensure the protection of such rights.
 1210         (2) RIGHT TO NONDISCRIMINATORY SERVICES.—
 1211         (a) Service providers may not deny an individual access to
 1212  substance abuse services solely on the basis of race, gender,
 1213  ethnicity, age, sexual preference, human immunodeficiency virus
 1214  status, prior service departures against medical advice,
 1215  disability, or number of relapse episodes. Service providers may
 1216  not deny an individual who takes medication prescribed by a
 1217  physician or an APRN-IP registered under s. 464.0123 access to
 1218  substance abuse services solely on that basis. Service providers
 1219  who receive state funds to provide substance abuse services may
 1220  not, if space and sufficient state resources are available, deny
 1221  access to services based solely on inability to pay.
 1222         Section 24. Effective July 1, 2020, paragraphs (i), (o),
 1223  and (r) of subsection (3) and paragraph (g) of subsection (5) of
 1224  section 456.053, Florida Statutes, are amended to read:
 1225         456.053 Financial arrangements between referring health
 1226  care providers and providers of health care services.—
 1227         (3) DEFINITIONS.—For the purpose of this section, the word,
 1228  phrase, or term:
 1229         (i) “Health care provider” means a any physician licensed
 1230  under chapter 458, chapter 459, chapter 460, or chapter 461; an
 1231  APRN-IP registered under s. 464.0123;, or any health care
 1232  provider licensed under chapter 463 or chapter 466.
 1233         (o)1. “Referral” means any referral of a patient by a
 1234  health care provider for health care services, including,
 1235  without limitation:
 1236         a.1. The forwarding of a patient by a health care provider
 1237  to another health care provider or to an entity which provides
 1238  or supplies designated health services or any other health care
 1239  item or service; or
 1240         b.2. The request or establishment of a plan of care by a
 1241  health care provider, which includes the provision of designated
 1242  health services or other health care item or service.
 1243         2.3. The following orders, recommendations, or plans of
 1244  care do not shall not constitute a referral by a health care
 1245  provider:
 1246         a. By a radiologist for diagnostic-imaging services.
 1247         b. By a physician specializing in the provision of
 1248  radiation therapy services for such services.
 1249         c. By a medical oncologist for drugs and solutions to be
 1250  prepared and administered intravenously to such oncologist’s
 1251  patient, as well as for the supplies and equipment used in
 1252  connection therewith to treat such patient for cancer and the
 1253  complications thereof.
 1254         d. By a cardiologist for cardiac catheterization services.
 1255         e. By a pathologist for diagnostic clinical laboratory
 1256  tests and pathological examination services, if furnished by or
 1257  under the supervision of such pathologist pursuant to a
 1258  consultation requested by another physician.
 1259         f. By a health care provider who is the sole provider or
 1260  member of a group practice for designated health services or
 1261  other health care items or services that are prescribed or
 1262  provided solely for such referring health care provider’s or
 1263  group practice’s own patients, and that are provided or
 1264  performed by or under the direct supervision of such referring
 1265  health care provider or group practice; provided, however, that
 1266  effective July 1, 1999, a health care provider physician
 1267  licensed pursuant to chapter 458, chapter 459, chapter 460, or
 1268  chapter 461 may refer a patient to a sole provider or group
 1269  practice for diagnostic imaging services, excluding radiation
 1270  therapy services, for which the sole provider or group practice
 1271  billed both the technical and the professional fee for or on
 1272  behalf of the patient, if the referring health care provider
 1273  does not have an physician has no investment interest in the
 1274  practice. The diagnostic imaging service referred to a group
 1275  practice or sole provider must be a diagnostic imaging service
 1276  normally provided within the scope of practice to the patients
 1277  of the group practice or sole provider. The group practice or
 1278  sole provider may accept no more than 15 percent of their
 1279  patients receiving diagnostic imaging services from outside
 1280  referrals, excluding radiation therapy services.
 1281         g. By a health care provider for services provided by an
 1282  ambulatory surgical center licensed under chapter 395.
 1283         h. By a urologist for lithotripsy services.
 1284         i. By a dentist for dental services performed by an
 1285  employee of or health care provider who is an independent
 1286  contractor with the dentist or group practice of which the
 1287  dentist is a member.
 1288         j. By a physician for infusion therapy services to a
 1289  patient of that physician or a member of that physician’s group
 1290  practice.
 1291         k. By a nephrologist for renal dialysis services and
 1292  supplies, except laboratory services.
 1293         l. By a health care provider whose principal professional
 1294  practice consists of treating patients in their private
 1295  residences for services to be rendered in such private
 1296  residences, except for services rendered by a home health agency
 1297  licensed under chapter 400. For purposes of this sub
 1298  subparagraph, the term “private residences” includes patients’
 1299  private homes, independent living centers, and assisted living
 1300  facilities, but does not include skilled nursing facilities.
 1301         m. By a health care provider for sleep-related testing.
 1302         (r) “Sole provider” means one health care provider licensed
 1303  under chapter 458, chapter 459, chapter 460, or chapter 461, or
 1304  registered under s. 464.0123, who maintains a separate medical
 1305  office and a medical practice separate from any other health
 1306  care provider and who bills for his or her services separately
 1307  from the services provided by any other health care provider. A
 1308  sole provider may not shall not share overhead expenses or
 1309  professional income with any other person or group practice.
 1310         (5) PROHIBITED REFERRALS AND CLAIMS FOR PAYMENT.—Except as
 1311  provided in this section:
 1312         (g) A violation of this section by a health care provider
 1313  shall constitute grounds for disciplinary action to be taken by
 1314  the applicable board pursuant to s. 458.331(2), s. 459.015(2),
 1315  s. 460.413(2), s. 461.013(2), s. 463.016(2), s. 464.018, or s.
 1316  466.028(2). Any hospital licensed under chapter 395 found in
 1317  violation of this section shall be subject to s. 395.0185(2).
 1318         Section 25. Effective July 1, 2020, subsection (1) of
 1319  section 626.9707, Florida Statutes, is amended to read:
 1320         626.9707 Disability insurance; discrimination on basis of
 1321  sickle-cell trait prohibited.—
 1322         (1) An No insurer authorized to transact insurance in this
 1323  state may not shall refuse to issue and deliver in this state
 1324  any policy of disability insurance, whether such policy is
 1325  defined as individual, group, blanket, franchise, industrial, or
 1326  otherwise, which is currently being issued for delivery in this
 1327  state and which affords benefits and coverage for any medical
 1328  treatment or service authorized and permitted to be furnished by
 1329  a hospital, a clinic, a health clinic, a neighborhood health
 1330  clinic, a health maintenance organization, a physician, a
 1331  physician’s assistant, an advanced practice registered nurse, an
 1332  APRN-IP registered under s. 464.0123 practitioner, or a medical
 1333  service facility or personnel solely because the person to be
 1334  insured has the sickle-cell trait.
 1335         Section 26. Effective July 1, 2020, section 627.64025,
 1336  Florida Statutes, is created to read:
 1337         627.64025 APRN-IP services.—A health insurance policy that
 1338  provides major medical coverage and that is delivered, issued,
 1339  or renewed in this state on or after January 1, 2021, may not
 1340  require an insured to receive services from an APRN-IP
 1341  registered under s. 464.0123 in place of a primary care
 1342  physician; incentivize the insured to do so through cost sharing
 1343  as defined in s. 627.42391 which is lower for services provided
 1344  by an APRN-IP than for the same services provided by a primary
 1345  care physician; or incentivize the insured do so through a
 1346  program authorized pursuant to s. 627.6387.
 1347         Section 27. Effective July 1, 2020, section 627.6621,
 1348  Florida Statutes, is created to read:
 1349         627.6621 APRN-IP services.—A group, blanket, or franchise
 1350  health insurance policy that is delivered, issued, or renewed in
 1351  this state on or after January 1, 2021, may not require an
 1352  insured to receive services from an APRN-IP registered under s.
 1353  464.0123 in place of a primary care physician; incentivize the
 1354  insured to do so through cost sharing as defined in s. 627.42391
 1355  which is lower for services provided by an APRN-IP than for the
 1356  same services provided by a primary care physician; or
 1357  incentivize the insured do so through a program authorized
 1358  pursuant to s. 627.6387.
 1359         Section 28. Effective July 1, 2020, paragraph (g) is added
 1360  to subsection (5) of section 627.6699, Florida Statutes, to
 1361  read:
 1362         627.6699 Employee Health Care Access Act.—
 1363         (5) AVAILABILITY OF COVERAGE.—
 1364         (g) A health benefit plan covering small employers which is
 1365  delivered, issued, or renewed in this state on or after January
 1366  1, 2021, may not require an insured to receive services from an
 1367  APRN-IP registered under s. 464.0123 in place of a primary care
 1368  physician; incentivize the insured to do so through cost sharing
 1369  as defined in s. 627.42391 which is lower for services provided
 1370  by an APRN-IP than for the same services provided by a primary
 1371  care physician; or incentivize the insured do so through a
 1372  program authorized pursuant to s. 627.6387.
 1373         Section 29. Effective July 1, 2020, paragraph (a) of
 1374  subsection (1) of section 627.736, Florida Statutes, is amended
 1375  to read:
 1376         627.736 Required personal injury protection benefits;
 1377  exclusions; priority; claims.—
 1378         (1) REQUIRED BENEFITS.—An insurance policy complying with
 1379  the security requirements of s. 627.733 must provide personal
 1380  injury protection to the named insured, relatives residing in
 1381  the same household, persons operating the insured motor vehicle,
 1382  passengers in the motor vehicle, and other persons struck by the
 1383  motor vehicle and suffering bodily injury while not an occupant
 1384  of a self-propelled vehicle, subject to subsection (2) and
 1385  paragraph (4)(e), to a limit of $10,000 in medical and
 1386  disability benefits and $5,000 in death benefits resulting from
 1387  bodily injury, sickness, disease, or death arising out of the
 1388  ownership, maintenance, or use of a motor vehicle as follows:
 1389         (a) Medical benefits.—Eighty percent of all reasonable
 1390  expenses for medically necessary medical, surgical, X-ray,
 1391  dental, and rehabilitative services, including prosthetic
 1392  devices and medically necessary ambulance, hospital, and nursing
 1393  services if the individual receives initial services and care
 1394  pursuant to subparagraph 1. within 14 days after the motor
 1395  vehicle accident. The medical benefits provide reimbursement
 1396  only for:
 1397         1. Initial services and care that are lawfully provided,
 1398  supervised, ordered, or prescribed by a physician licensed under
 1399  chapter 458 or chapter 459, a dentist licensed under chapter
 1400  466, or a chiropractic physician licensed under chapter 460, or
 1401  an APRN-IP registered under s. 464.0123 or that are provided in
 1402  a hospital or in a facility that owns, or is wholly owned by, a
 1403  hospital. Initial services and care may also be provided by a
 1404  person or entity licensed under part III of chapter 401 which
 1405  provides emergency transportation and treatment.
 1406         2. Upon referral by a provider described in subparagraph
 1407  1., followup services and care consistent with the underlying
 1408  medical diagnosis rendered pursuant to subparagraph 1. which may
 1409  be provided, supervised, ordered, or prescribed only by a
 1410  physician licensed under chapter 458 or chapter 459, a
 1411  chiropractic physician licensed under chapter 460, a dentist
 1412  licensed under chapter 466, or an APRN-IP registered under s.
 1413  464.0123 or, to the extent permitted by applicable law and under
 1414  the supervision of such physician, osteopathic physician,
 1415  chiropractic physician, or dentist, by a physician assistant
 1416  licensed under chapter 458 or chapter 459 or an advanced
 1417  practice registered nurse licensed under chapter 464. Followup
 1418  services and care may also be provided by the following persons
 1419  or entities:
 1420         a. A hospital or ambulatory surgical center licensed under
 1421  chapter 395.
 1422         b. An entity wholly owned by one or more physicians
 1423  licensed under chapter 458 or chapter 459, chiropractic
 1424  physicians licensed under chapter 460, APRN-IPs registered under
 1425  s. 464.0123, or dentists licensed under chapter 466 or by such
 1426  practitioners and the spouse, parent, child, or sibling of such
 1427  practitioners.
 1428         c. An entity that owns or is wholly owned, directly or
 1429  indirectly, by a hospital or hospitals.
 1430         d. A physical therapist licensed under chapter 486, based
 1431  upon a referral by a provider described in this subparagraph.
 1432         e. A health care clinic licensed under part X of chapter
 1433  400 which is accredited by an accrediting organization whose
 1434  standards incorporate comparable regulations required by this
 1435  state, or
 1436         (I) Has a medical director licensed under chapter 458,
 1437  chapter 459, or chapter 460;
 1438         (II) Has been continuously licensed for more than 3 years
 1439  or is a publicly traded corporation that issues securities
 1440  traded on an exchange registered with the United States
 1441  Securities and Exchange Commission as a national securities
 1442  exchange; and
 1443         (III) Provides at least four of the following medical
 1444  specialties:
 1445         (A) General medicine.
 1446         (B) Radiography.
 1447         (C) Orthopedic medicine.
 1448         (D) Physical medicine.
 1449         (E) Physical therapy.
 1450         (F) Physical rehabilitation.
 1451         (G) Prescribing or dispensing outpatient prescription
 1452  medication.
 1453         (H) Laboratory services.
 1454         3. Reimbursement for services and care provided in
 1455  subparagraph 1. or subparagraph 2. up to $10,000 if a physician
 1456  licensed under chapter 458 or chapter 459, a dentist licensed
 1457  under chapter 466, a physician assistant licensed under chapter
 1458  458 or chapter 459, or an advanced practice registered nurse
 1459  licensed under chapter 464, or an APRN-IP registered under s.
 1460  464.0123 has determined that the injured person had an emergency
 1461  medical condition.
 1462         4. Reimbursement for services and care provided in
 1463  subparagraph 1. or subparagraph 2. is limited to $2,500 if a
 1464  provider listed in subparagraph 1. or subparagraph 2. determines
 1465  that the injured person did not have an emergency medical
 1466  condition.
 1467         5. Medical benefits do not include massage as defined in s.
 1468  480.033 or acupuncture as defined in s. 457.102, regardless of
 1469  the person, entity, or licensee providing massage or
 1470  acupuncture, and a licensed massage therapist or licensed
 1471  acupuncturist may not be reimbursed for medical benefits under
 1472  this section.
 1473         6. The Financial Services Commission shall adopt by rule
 1474  the form that must be used by an insurer and a health care
 1475  provider specified in sub-subparagraph 2.b., sub-subparagraph
 1476  2.c., or sub-subparagraph 2.e. to document that the health care
 1477  provider meets the criteria of this paragraph. Such rule must
 1478  include a requirement for a sworn statement or affidavit.
 1479  
 1480  Only insurers writing motor vehicle liability insurance in this
 1481  state may provide the required benefits of this section, and
 1482  such insurer may not require the purchase of any other motor
 1483  vehicle coverage other than the purchase of property damage
 1484  liability coverage as required by s. 627.7275 as a condition for
 1485  providing such benefits. Insurers may not require that property
 1486  damage liability insurance in an amount greater than $10,000 be
 1487  purchased in conjunction with personal injury protection. Such
 1488  insurers shall make benefits and required property damage
 1489  liability insurance coverage available through normal marketing
 1490  channels. An insurer writing motor vehicle liability insurance
 1491  in this state who fails to comply with such availability
 1492  requirement as a general business practice violates part IX of
 1493  chapter 626, and such violation constitutes an unfair method of
 1494  competition or an unfair or deceptive act or practice involving
 1495  the business of insurance. An insurer committing such violation
 1496  is subject to the penalties provided under that part, as well as
 1497  those provided elsewhere in the insurance code.
 1498         Section 30. Effective July 1, 2020, subsection (5) of
 1499  section 633.412, Florida Statutes, is amended to read:
 1500         633.412 Firefighters; qualifications for certification.—A
 1501  person applying for certification as a firefighter must:
 1502         (5) Be in good physical condition as determined by a
 1503  medical examination given by a physician, surgeon, or physician
 1504  assistant licensed under to practice in the state pursuant to
 1505  chapter 458; an osteopathic physician, a surgeon, or a physician
 1506  assistant licensed under to practice in the state pursuant to
 1507  chapter 459; or an advanced practice registered nurse licensed
 1508  under to practice in the state pursuant to chapter 464; or an
 1509  APRN-IP registered under s. 464.0123. Such examination may
 1510  include, but need not be limited to, the National Fire
 1511  Protection Association Standard 1582. A medical examination
 1512  evidencing good physical condition shall be submitted to the
 1513  division, on a form as provided by rule, before an individual is
 1514  eligible for admission into a course under s. 633.408.
 1515         Section 31. Effective July 1, 2020, section 641.31075,
 1516  Florida Statutes, is created to read:
 1517         641.31075APRN-IP services.—A health maintenance contract
 1518  that is delivered, issued, or renewed in this state on or after
 1519  January 1, 2021, may not require a subscriber to receive
 1520  services from an APRN-IP registered under s. 464.0123 in place
 1521  of a primary care physician; incentivize the subscriber to do so
 1522  through cost sharing as defined in s. 641.313 which is lower for
 1523  services provided by an APRN-IP than for the same services
 1524  provided by a primary care physician; or incentivize the
 1525  subscriber do so through a program authorized pursuant to s.
 1526  641.31076.
 1527         Section 32. Effective July 1, 2020, subsection (8) of
 1528  section 641.495, Florida Statutes, is amended to read:
 1529         641.495 Requirements for issuance and maintenance of
 1530  certificate.—
 1531         (8) Each organization’s contracts, certificates, and
 1532  subscriber handbooks shall contain a provision, if applicable,
 1533  disclosing that, for certain types of described medical
 1534  procedures, services may be provided by physician assistants,
 1535  advanced practice registered nurses, APRN-IPs registered under
 1536  s. 464.0123 nurse practitioners, or other individuals who are
 1537  not licensed physicians.
 1538         Section 33. Effective July 1, 2020, paragraph (b) of
 1539  subsection (1) of section 744.3675, Florida Statutes, is amended
 1540  to read:
 1541         744.3675 Annual guardianship plan.—Each guardian of the
 1542  person must file with the court an annual guardianship plan
 1543  which updates information about the condition of the ward. The
 1544  annual plan must specify the current needs of the ward and how
 1545  those needs are proposed to be met in the coming year.
 1546         (1) Each plan for an adult ward must, if applicable,
 1547  include:
 1548         (b) Information concerning the medical and mental health
 1549  conditions and treatment and rehabilitation needs of the ward,
 1550  including:
 1551         1. A resume of any professional medical treatment given to
 1552  the ward during the preceding year.
 1553         2. The report of a physician or an APRN-IP registered under
 1554  s. 464.0123 who examined the ward no more than 90 days before
 1555  the beginning of the applicable reporting period. The report
 1556  must contain an evaluation of the ward’s condition and a
 1557  statement of the current level of capacity of the ward.
 1558         3. The plan for providing medical, mental health, and
 1559  rehabilitative services in the coming year.
 1560         Section 34. Effective July 1, 2020, paragraph (c) of
 1561  subsection (1) of section 766.118, Florida Statutes, is amended
 1562  to read:
 1563         766.118 Determination of noneconomic damages.—
 1564         (1) DEFINITIONS.—As used in this section, the term:
 1565         (c) “Practitioner” means any person licensed or registered
 1566  under chapter 458, chapter 459, chapter 460, chapter 461,
 1567  chapter 462, chapter 463, chapter 466, chapter 467, chapter 486,
 1568  or s. 464.012, or s. 464.0123. “Practitioner” also means any
 1569  association, corporation, firm, partnership, or other business
 1570  entity under which such practitioner practices or any employee
 1571  of such practitioner or entity acting in the scope of his or her
 1572  employment. For the purpose of determining the limitations on
 1573  noneconomic damages set forth in this section, the term
 1574  “practitioner” includes any person or entity for whom a
 1575  practitioner is vicariously liable and any person or entity
 1576  whose liability is based solely on such person or entity being
 1577  vicariously liable for the actions of a practitioner.
 1578         Section 35. Effective July 1, 2020, subsection (3) of
 1579  section 768.135, Florida Statutes, is amended to read:
 1580         768.135 Volunteer team physicians; immunity.—
 1581         (3) A practitioner licensed or registered under chapter
 1582  458, chapter 459, chapter 460, or s. 464.012, or s. 464.0123 who
 1583  gratuitously and in good faith conducts an evaluation pursuant
 1584  to s. 1006.20(2)(c) is not liable for any civil damages arising
 1585  from that evaluation unless the evaluation was conducted in a
 1586  wrongful manner.
 1587         Section 36. Effective July 1, 2020, subsection (2) of
 1588  section 960.28, Florida Statutes, is amended to read:
 1589         960.28 Payment for victims’ initial forensic physical
 1590  examinations.—
 1591         (2) The Crime Victims’ Services Office of the department
 1592  shall pay for medical expenses connected with an initial
 1593  forensic physical examination of a victim of sexual battery as
 1594  defined in chapter 794 or a lewd or lascivious offense as
 1595  defined in chapter 800. Such payment shall be made regardless of
 1596  whether the victim is covered by health or disability insurance
 1597  and whether the victim participates in the criminal justice
 1598  system or cooperates with law enforcement. The payment shall be
 1599  made only out of moneys allocated to the Crime Victims’ Services
 1600  Office for the purposes of this section, and the payment may not
 1601  exceed $1,000 with respect to any violation. The department
 1602  shall develop and maintain separate protocols for the initial
 1603  forensic physical examination of adults and children. Payment
 1604  under this section is limited to medical expenses connected with
 1605  the initial forensic physical examination, and payment may be
 1606  made to a medical provider using an examiner qualified under
 1607  part I of chapter 464, excluding s. 464.003(15) s. 464.003(14);
 1608  chapter 458; or chapter 459. Payment made to the medical
 1609  provider by the department shall be considered by the provider
 1610  as payment in full for the initial forensic physical examination
 1611  associated with the collection of evidence. The victim may not
 1612  be required to pay, directly or indirectly, the cost of an
 1613  initial forensic physical examination performed in accordance
 1614  with this section.
 1615         Section 37. For the 2020-2021 fiscal year, the sums of
 1616  $400,764 in recurring funds and $408,731 in nonrecurring funds
 1617  from the Health Care Trust Fund are appropriated to the Agency
 1618  for Health Care Administration, and three full-time equivalent
 1619  positions with associated salary rate of 125,887 and three other
 1620  personal services positions are authorized, for the purpose of
 1621  implementing sections 400.52 and 408.822, Florida Statutes, as
 1622  created by this act.
 1623         Section 38. For the 2020-2021 fiscal year, the sums of
 1624  $202,019 in recurring funds and $24,272 in nonrecurring funds
 1625  from the Medical Quality Assurance Trust Fund are appropriated
 1626  to the Department of Health, and four full-time equivalent
 1627  positions with associated salary rate of 121,246 are authorized,
 1628  for the purpose of implementing section 464.0123, Florida
 1629  Statutes, as created by this act.
 1630         Section 39. Except as otherwise expressly provided in this
 1631  act, this act shall take effect upon becoming a law.

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