Automated Pharmacy Systems
Effective Date: July 1, 2020
HB 59 (Full Text)

Summary:
The bill expands current law to authorize a community pharmacy to provide outpatient dispensing through the use of an automated pharmacy system. The bill establishes criteria for such systems and a community pharmacy’s responsibilities when employing such a system.

Health Care for Children
Effective Date: July 1, 2020
HB 81 (Full Text)

Summary:
The bill creates section 456.0496, Florida Statutes, requiring certain health care practitioners to ensure that the informational pamphlet on the screening for, and treatment of, preventable infant and childhood eye and vision disorders is provided to parents after a planned out-of-hospital birth.

Keep Our Graduates Working Act
Effective Date: July 1, 2020
HB 115 (Full Text)

Summary:
The bill prohibits the Department of Health (DOH) from denying the issuance of, refusing to renew, suspending, or revoking a professional license based solely on the licensee being delinquent on a payment of or defaulting on his or her student loans. The bill removes the specific provision allowing DOH to discipline a health care practitioner for failing to repay a student loan and the associated mandatory discipline. The bill repeals the requirement that DOH must issue an emergency order suspending a health care practitioner’s license for a student loan default, absent timely proof of a new repayment plan. Additionally, the bill repeals the requirement that DOH must obtain a monthly list from the United States Health and Human Services (USHHS) of the health care practitioners who have defaulted on their student loans.

Practice of Pharmacy
Effective Date: July 1, 2020
HB 389 (Full Text)

Summary:
The bill authorizes a pharmacist to enter into a collaborative pharmacy practice agreement (CPPA) with a physician to manage chronic health conditions if the pharmacist meets certain qualifications. A CPPA must meet certain terms and specify the health conditions, treatments, and tests governed by the CPPA. The bill prohibits a collaborating pharmacist from modifying or discontinuing any medication that is prescribed by a health care practitioner with whom he or she does not enter into a CPPA and from initiating or prescribing a controlled substance.

The bill authorizes a pharmacist, who meets certain qualifications, to test or screen for and treat minor, nonchronic health conditions within the framework of a written protocol with a supervising physician. The conditions are limited to influenza, streptococcus, lice, skin conditions, and minor, uncomplicated infections. The protocol must specify the patients that may be seen, instructions for obtaining a patient’s medical history, instructions for treatment, and a process and schedule for the pharmacist to provide patient information to the supervising physician and the supervising physician to review the pharmacist’s actions under the protocol.

The bill requires the Board of Pharmacy to adopt, by rule, a formulary of medicinal drugs that an authorized pharmacist may prescribe to treat minor, non-chronic health conditions. A pharmacist may not prescribe any controlled substance; however, the Board-developed formulary may include any non-controlled substance, including those that typically need a prescription to dispense, such as antibiotics, and over-the-counter medications. The bill authorizes a pharmacist to use certain laboratory or clinical tests, as well as any established screening procedures for which no test is available.

A pharmacy in which a pharmacist provides services for minor, non-chronic health conditions must prominently display a sign advising a patient receiving such services to seek follow-up care from a physician. The Board of Pharmacy shall adopt guidelines for the circumstances under which the information required under this subsection shall be provided.

Physical Therapy Practice
Effective Date: July 1, 2020
HB 467 (Full Text)

Summary:
This bill modernizes the definitions of “physical therapy assessment” and the “practice of physical therapy” to reflect current practice and authorizes the Board of Physical Therapy Practice to adopt rules related to the standards of practice for physical therapists (PT) to perform dry needling. The bill establishes minimum experience, education, and training requirements for PTs who perform dry needling.

Institutional Formularies Established by Nursing Home Facilities
Effective Date: July 1, 2020
HB 559 (Full Text)

Summary:
The bill authorizes a nursing home to establish an institutional formulary by which a pharmacist may use therapeutic substitution, without obtaining a new prescription, to replace a resident’s prescribed drug with a chemically different drug listed in the formulary that is expected to have the same clinical effect.
The bill requires a nursing home to obtain a prescriber’s authorization to use an institutional formulary for each of the prescriber’s patients in the nursing home and allows a prescriber to opt out of the institutional formulary for a specific drug or a class of drugs. The nursing home must notify the prescriber prior to each therapeutic substitution and document the resident’s medical record when a substitution occurs. The bill requires a nursing home to obtain informed consent from a resident or a resident’s representative to use the institutional formulary for the resident.
The bill prohibits a nursing home from taking adverse action against a prescriber or resident who refuses to use the institutional formulary.

Consultant Pharmacists
Effective Date: July 1, 2020
HB 599 (Full Text)

Summary:
The bill revises requirements and responsibilities of a consultant pharmacist by authorizing a consultant pharmacist to enter into a written collaborative practice agreement to provide medication management services with a health care facility medical director or Florida-licensed allopathic physician, osteopathic physician, podiatric physician, or dentist to:
 

• Order and evaluate laboratory and clinical testing;
• Conduct patient assessments;
• Administer medications; and
• Modify or discontinue medicinal drugs pursuant to a patient-specific order or treatment protocol.

A consultant pharmacist may only provide services to the patients of the health care practitioner with whom the consultant pharmacist has a written collaborative practice agreement. The bill requires both the consultant pharmacist and health care practitioner to maintain a copy of the collaborative agreement and make it available upon request or during an inspection. The bill also requires the consultant pharmacist to maintain all drug, patient care, and quality assurance records.

The bill authorizes a consultant pharmacist to provide services to patients in an ambulatory surgical center, hospital, alcohol or chemical dependency treatment center, inpatient hospice, or ambulatory care center, in addition to those authorized in current law (nursing home and home health agency patients). The bill clarifies that a consultant pharmacist is not authorized to diagnose any disease or condition, and authorizes the Board of Pharmacy to establish additional education requirements for licensure as a consultant pharmacist.

The bill also authorizes a pharmacist to make recommendations regarding the patient’s health care status with the patient’s prescribing health care practitioner or others specifically authorized by the patient.

Direct Care Workers and Autonomous APRNs
Effective Date: Upon Becoming a Law (March 11,2020) and July 1, 2020
HB 607 (Full Text)

Summary:
The Board of Nursing voted to initiate rulemaking on various aspects of HB 607 during its meetings on June 5, 2020. You can access the minutes of the full board and long-range policy planning discussions from the “meetings” link on the Board website.

The registration application for autonomous APRNs will be available after it has been adopted by rule, which is anticipated to take approximately 90 days. The Board voted to approve the application and move forward with rulemaking at its June 5th meeting. The Board also voted to define “primary care practice” to include “health promotion, disease prevention, health maintenance, counselling, patient education, and diagnosis and treatment of acute and chronic illnesses in a variety of healthcare settings”. This definition will also move through the rulemaking adoption process prior to becoming effective.

The Board determined that an equivalency to the required graduate level coursework required for registration would be 45 CE hours in each of the required subject areas. These hours must be offered by a Board-approved provider or a national organization empowered to accredit nursing CE. The courses must have been taken within the 5 years preceding the registration application. Submitted courses must have documentation of differential diagnosis and pharmacology in the course description and objectives.

Appointments to the Council on APRN Autonomous Practice will be finalized by the end of June 2020 and then a meeting of the Council will be scheduled and announced. The Council is charged with developing “standards of practice” to recommend to the Board for adoption by rule.

Additional discussions on HB 607 will take place during the Board’s August 6-7, 2020, meeting.

Governor DeSantis signed HB 607 into law on March 11, 2020.

Separate portions of HB 607, now referred to as Chapter 2020-9, Laws of Florida, impact Board of Nursing licensees. Please see below for highlights of the new legislation:

Sections 12-14 – went into effect on 3/11/20

An authorized RN may delegate tasks to CNAs or home health aides if the RN determines that the CNA or home health aide is competent to perform these tasks, that the tasks are delegable under applicable Federal law, and the tasks meet certain criteria designated in the law. The RN is not authorized to delegate the administration of Schedule II-IV controlled substances. The Board is directed to adopt rules implementing the new law in consultation with the Agency for Health Care Administration (AHCA). We anticipate the rulemaking will commence following the Board’s June 2020 meeting.

Training coursework is required in order for a CNA to administer medication under an RN’s delegation. CNAs will also be required to have 2 hours of in-service training in medication administration and medical error prevention on a yearly basis.

The Board, along with AHCA, will also create standards and procedures for CNAs to follow when administering medication in a home health setting.

Sections 22-26 – go into effect on 7/1/20

APRNs will have an opportunity to register for autonomous practice, which will remove the requirement to provide patient care within the framework of an established protocol with a supervising physician or dentist. Registration eligibility requirements are established in the legislation and include: no discipline within 5 years of applying for the registration; completion of 3,000 clinical practice hours as an APRN under the supervision of physician within the 5 years immediately preceding the registration request; and, within the past 5 years, completion of graduate-level semester hours, or the equivalent, in differential diagnosis and pharmacology (3 hours in each subject). The registration application will be available after July 1, 2020.

Financial responsibility requirements are established in the new law for APRN autonomous practice. Practice requirements are also in the legislation and will be interpreted by the Board during its June 2020 meeting as part of the implementation of the bill.

A Council on APRN Autonomous Practice is created within the Department of Health and will recommend standards of practice to the Board.

Additional continuing education (CE) requirements are put in place for autonomous practice. Ten hours of CE, approved by the Board, must be completed at each renewal in addition to completing the 30 hours of CE already in place, even if the APRN is exempt from existing CE requirements due to his or her national certification.

Autonomous APRNs must also now report adverse incidents as outlined in the legislation and additional disciplinary actions are added to the Nurse Practice Act.

Updates on the implementation of this law will be added to the website.

Department of Health
Effective Date: July 1, 2020
HB 713 (Full Text)

Summary:
The bill amends numerous practice acts to streamline regulation and increase efficiency. The bill makes numerous updates and changes to programs and health care professions regulated under the boards and Department of Health (DOH):

• The bill grants rulemaking authority to DOH for responsibilities relating to maximizing the use of existing programs and coordinating stakeholders and resources to develop a state strategic plan, including the process of selecting physicians under the Conrad 30 Waiver Program, and to encourage qualified physicians to relocate to Florida and practice in medically underserved and rural areas;
• Requires an applicant for a health care professional license to provide his or her date of birth on the application;
• Revises the DOH’s health care practitioner licensing provisions to permit the DOH to issue a temporary license, that expires in 60 days instead of 30 days, to a non-resident or non-citizen physician who has accepted a residency, internship, or fellowship in Florida and has not yet received a social security number;
• Creates an exception to the 15-percent cap for self-referral for diagnostic imaging services normally imposed on solo or group practice settings for group practice entities that own an accountable care organization or an entity operating under an advanced alternative payment model, according to federal regulations, if such entity provides diagnostic imaging services and has more than 30,000 patients enrolled per year;
• Repeals a health care practitioner’s failure to repay student loans as grounds for discipline by the DOH;
• Authorizes the DOH to issue medical faculty certificates to certain full-time faculty members of Nova Southeastern University and Lake Erie College of Osteopathic Medicine;
• Repeals the requirement that the Board of Medicine (BOM) conduct a triennial review of organizations that board-certify physicians in dermatology;
• Revises the composition of the Council on Physician Assistants, under the BOM, from four physicians and one physician assistant, to two physicians and three physician assistants;
• Revises the requirements for osteopathic internships and residencies to include those accredited by the Accreditation Council for Graduate Medical Education;
• Deregulates registered chiropractic assistants;
• Effective upon the bill becoming a law, allows a nursing education program seeking accreditation to apply to the Board of Nursing (BON) for a single extension of not more than two years if the program meets specific criteria and grants the BON rulemaking authority on criteria to qualify for the extension;
• Grants rulemaking authority to the BON to establish standards of practice, including discipline, for certified nursing assistants (CNA);
• Recognizes CNA certification in a U.S. territory or the District of Columbia for certification in Florida and eliminates the element of intent for violations of the practice act by CNAs;
• Defines the supplemental general dentistry education required for dental licensure applicants who have not graduated from a dental school accredited by the American Dental Association Commission on Dental Accreditation to exclude education in an advanced dental specialty;
• Repeals the requirement that dental and dental hygienist licensure examinations must be graded by Florida-licensed dentists and dental hygienists;
• Effective upon the bill becoming a law and applying retroactively to January 1, 2020, revives, reenacts, and amends statutory provisions relating to health access dental licenses, notwithstanding their sunset on January 1, 2020;
• Requires dentists and dental hygienists to report adverse incidents to the Board of Dentistry (BOD) and gives the BOD rulemaking authority;
• Authorizes an employee or independent contractor of a dental laboratory to engage in onsite consultation with a licensed dentist during a dental procedure and requires a dental laboratory to be inspected at least biennially;
• Requires an athletic trainer to work within his or her scope of practice as defined by the Board of Athletic Training and revises the educational and internship requirements for licensure;
• Requires the DOH to issue a single prosthetist-orthotist license to qualified applicants and establishes the educational requirements for duel registration;
• Revises massage therapy licensure requirements to:
• Repeal Board of Massage Therapy (BMT) departmental examinations and require a BMT-specified national examination;
• Eliminate massage apprenticeships as a path to licensure by 2023; and
• Revise the definition of a massage therapy “apprentice” to include only those persons approved by the BMT to study colonic irrigation under a licensed massage therapist;
• Updates the name of the accreditation body for psychology programs and revises the requirements for psychology licensure;
• Limits the Board of Clinical Social Work, Marriage and Family Therapists, and Mental Health Counseling to the issuance of only one additional internship registration;
• Revises the education, clinical, and licensure requirements for marriage and family therapists and licensed mental health counselors, including updating the program accrediting agencies;

Nonopioid Alternatives
Effective Date: July 1, 2020
HB 743 (Full Text)

Summary:
The bill revises the requirements for certain health care practitioners providing an opioid drug listed as a Schedule II controlled substance to inform the patient about possible nonopioid alternatives, discuss the advantages and disadvantages of nonopioid alternatives, and provide the pamphlet as required in section 456.44, Florida Statutes by:

• Requiring that the pamphlet provided to the patient be printed;
• Authorizing a health care practitioner to discuss non-opioid alternatives with, and provide the pamphlet to, the patient’s representative rather than the patient;
• Specifying that only those health care practitioners ordering or prescribing or providing care that requires the administration of anesthesia using an opioid must meet the requirements and removing the requirement to address non-opioid alternatives when a drug is dispensed or administered; and
• Exempting health care practitioners providing hospice services and providing care in a hospital critical care unit or emergency department from the requirement to discuss non-opioid alternatives with a patient or the patient’s representative and provide a printed copy of the pamphlet.

Nonopioid Alternatives
Effective Date: July 1, 2020
HB 743 (Full Text)

Summary:
The bill revises the requirements for certain health care practitioners providing an opioid drug listed as a Schedule II controlled substance to inform the patient about possible nonopioid alternatives, discuss the advantages and disadvantages of nonopioid alternatives, and provide the pamphlet as required in section 456.44, Florida Statutes by:

• Requiring that the pamphlet provided to the patient be printed;
• Authorizing a health care practitioner to discuss non-opioid alternatives with, and provide the pamphlet to, the patient’s representative rather than the patient;
• Specifying that only those health care practitioners ordering or prescribing or providing care that requires the administration of anesthesia using an opioid must meet the requirements and removing the requirement to address non-opioid alternatives when a drug is dispensed or administered; and
• Exempting health care practitioners providing hospice services and providing care in a hospital critical care unit or emergency department from the requirement to discuss non-opioid alternatives with a patient or the patient’s representative and provide a printed copy of the pamphlet.

Deregulation of Professions and Occupations
Effective Date: July 1, 2020
HB 1193 (Full Text)

Summary:
The bill amends section 468.505, Florida Statutes, providing that certain unlicensed persons are not prohibited or restricted from his or her practice, services, or activities in dietetics and nutrition under certain circumstances.

Health Access Dental Licenses
Effective Date: Upon becoming a law
HB 1461 (Full Text)

Summary:
This bill reestablishes the licensure, renewal, and revocation of health access dental licenses.

Licensure Requirement for Osteopathic Physicians
Effective Date: Upon becoming a law (not signed yet)
Senate Bill 218 (Full Text)

Summary:
The bill revises section 459.0055(1)(l), Florida Statutes, to update the organizations which accredit residency programs for Osteopathic Physicians, allowing applicants who completed programs accredited by the American Council for Graduate Medical Education (ACGME) to be licensed.

Athletic Trainers
Effective Date: July 1, 2020
Senate Bill 226 (Full Text)

Summary:
This bill requires an athletic trainer to work within his or her scope of practice as defined by the Board of Athletic Training and revises the educational and internship requirements for licensure.

Abortion
Effective Date: July 1, 2020
Senate Bill 404 (Full Text)

Summary:
The bill prohibits a physician from performing an abortion on a minor unless the physician has received a notarized, written consent statement signed by the minor and her mother, father, or legal guardian and the physician has been presented with proof of identification and proof of parentage or guardianship by the parent or legal guardian. However, the consent requirement does not apply if:

• Notice is not required under specified exceptions to the parental notice requirement;
• The abortion is performed during a medical emergency when there is insufficient time to obtain consent;
• The parent or guardian has waived the right to consent; or
• The minor petitions the circuit court where she resides and receives a judicial waiver of parental consent.

The bill also authorizes a third-degree felony penalty for a physician who recklessly or intentionally performs, or attempts to perform, an abortion on an unemancipated minor without the required consent. The bill also increases the penalty for violating requirements established for infants born alive in section 390.0111(12), Florida Statutes, from a first-degree misdemeanor to a third-degree felony.

Reproductive Health
Effective Date: July 1, 2020
Senate Bill 698 (Full Text)

Summary:
The bill requires the Department of Health (DOH), the Board of Medicine, or the Board of Osteopathic Medicine may take disciplinary action against the health care practitioner’s license if he or she intentionally transfers an embryo or reproductive material into a recipient without the recipient’s consent. Additionally, the DOH may issue an emergency order suspending the practitioner’s license if he or she is found guilty of committing the felony of reproductive battery, which is discussed below.

The bill also requires a health care practitioner, a medical student, or any other student who is receiving training as a health care practitioner to obtain the written consent of a patient or a patient’s representative before performing a pelvic exam. Written consent for the pelvic exam is not required if a court orders the exam to collect evidence or if the exam is necessary to avert a serious risk of irreversible impairment of a major bodily function of the patient.

The bill creates the crime of reproductive battery. It is a third-degree felony for a health care practitioner to intentionally transfer human reproductive material into the body of a recipient or implant a human embryo of a donor, knowing that the recipient has not consented to the use of the reproductive material or embryo from that donor. If the health care practitioner is the donor of the reproductive material, the penalty is increased to a second-degree felony.

The statute of limitations for prosecuting the crime of reproductive battery does not begin to run until the date that the violation is discovered and reported to a law enforcement agency or any other governmental agency. Additionally, it is not a defense to the crime that the recipient consented to the use of an anonymous donor.

Emotional Support Animals
Effective Date: July 1, 2020
Senate Bill 1084 (Full Text)

Summary:
The bill amends Florida’s Fair Housing Act by prohibiting a housing provider, to the extent required by federal law, rule, or regulation, to deny housing to a person with a disability or a disability-related need who has an animal that is required as support. It defines emotional support animal as an animal that is not required to be trained to assist a person with a disability but, by virtue of its presence, provides support to alleviate one or more identified symptoms or effects of a person’s disability.

Written documentation that reasonably supports that a person has a disability may be provided by any federal, state, or local government agency, specified health care practitioners, telehealth providers, or out-of-state practitioners who have provided in-person care or services to the tenant on at least one occasion. The bill prohibits a housing provider to request information that discloses the diagnosis or severity of a person’s disability or any medical records relating to the disability.

The bill creates a new cause for disciplinary action against a health care practitioner’s license for providing supporting information for an emotional support animal, without personal knowledge of the patient’s disability or disability-related need. It also creates the misdemeanor crime of providing false or fraudulent emotional support animal information or documentation and requires a convicted person to perform 30 hours of community service for an organization serving persons with disabilities, or another entity or organization the court determines appropriate.

Home Medical Equipment Providers
Effective Date: July 1, 2020
Senate Bill 1742 (Full Text)

Summary:
The bill exempts medical doctors, osteopathic physicians, and chiropractic physicians from the requirement to be licensed as a home medical equipment provider in order to sell or rent electrostimulation medical equipment and supplies to their own patients in the course of their practice.