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Do I need to Register to Perform In-Office Surgeries in Florida

Developments of new drugs and medical technology have enabled physicians to perform treatments and procedures in the comfort of medical offices that were once only able to be performed in hospital settings. To confirm whether obtaining an Office Surgery License is required for your office to perform these surgeries you must carefully examine the rules on office surgeries because they have changed recently.

 

The Office Surgery Rule

On June 25, 2019, Governor Ron DeSantis signed Senate Bill 732 into law. This rule provides guidance on how office procedures can be performed. It also delivers certain standards for these offices and requires that any office performing office surgery procedures be registered with the Department of State. As of January 2020, all offices performing liposuctions over 1000ccs, or Level 2 or Level 3 surgeries must register and comply with statute requirements. According to the Florida Board of Medicine, any office performing “Level 2 procedures lasting more than 5 minutes, and all level 3 surgical procedures in an office setting must register the office with the department unless that office is licensed as a facility under chapter 395, 458.309(3) F.A.C.)”. In any case, office surgical procedures should not result in blood loss of more than 10 percent of estimated blood volume in a patient or directly engage any main blood vessels, or be considered life threatening in nature.

 

What are the levels of Office Surgery?

Level 1 Surgeries are procedures that require none to minimal pre-operative medications or tranquilizations. Any anesthesia used must be local and conscious altering medication is not administered. This includes but is not limited to excision of moles, warts, lesions, cysts; liposuction, removing less than 4000cc of fat, skin biopsies, drainage of superficial abscesses, etc.

Level 2 Surgeries can use sedation or peri-operative medicines that alter levels of consciousness which, in turn, require some post-operative monitoring. These procedures include, but are not limited to breast biopsies, colonoscopies, hernia repair, etc.

Level 3 Surgeries are procedures that absolutely should utilize general anesthesia or pre-operative sedation. This can include intravenous sedation, major conductive anesthesia, and general anesthesia.

For each level, there are specific outlines for medication, equipment, and registration requirements which can be found by visiting: http://www.doh.state.fl.us/mqa/medical/osr_home.html.

 

Pain Management Facilities

While anesthesia blocks are considered ‘surgical procedures’ by the Florida Board of Medicine, the level of sedation would determine the surgery procedure level.

 

How to Register for an Office Surgery License

The registering Surgeon should submit an Office Surgery Registration form with an original signature. The office must also provide proof of completion of necessary training (i.e. certificates/diplomas) by all physicians. If any physicians that will also be performing Level 2 or Level 3 surgeries are hired to the office after the approval, the Department must be notified immediately to update records.

 

Other Requirements

If an office plans to engage in surgeries that require a license and recognition with the Department of Health, there are ethics standards to be upheld and requirements that must be complied with. The requesting medical offices are subject to be inspected by the Department of Health and each office should have a designated physician responsible for ensuring compliance. Medical offices also need to exhibit the required minimal financial responsibility as outlined by the State.

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It should be noted that I am not your lawyer (unless you have presently retained my services through a retainer agreement). This post is not intended as legal advice, it is purely educational and informational, and no attorney-client relationship shall result after reading it. Please consult your own attorney for legal advice. If you do not have one and would like to retain my legal services, please contact me using the contact information listed above.

 

All information and references made to laws, rules, regulations, and advisory opinions were accurate based on the law as it existed at this time, but laws are constantly evolving. Please contact me to be sure that the law which will govern your business is current. Thank you.

How to Open a Group Home for Children, Disabled Persons, and the Elderly in Florida

What is A Group Home?

A group home by definition is a residence that offers full time care for those who are unable to care for themselves. Group homes offer assistance for those who are unable to care for themselves due to age or medical disability and can’t be cared for by family members.

Group homes are usually smaller than other care facilities with more centralized care and fewer residents (usually 6 beds or under). Typically, 24-hour care and supervision is provided by at least one caregiver around the clock. Group Homes are not typically responsible for the personal care of residents such as bathing or using facilities. While health insurance does not typically cover the cost of a group home, long term care insurance might.

Who Can A Group Home Serve?

Children. Children who are unable to safely remain in their homes and have been removed from their parent or guardian may be placed in a home with full time supervision. They are placed in the custody of the Department of Children and Families and are then placed in a group home if foster is not a viable fit.

Disabled persons. Persons with disabilities who are unable to care for themselves may also find support in a group home. These facilities can offer training and basic life skills for individuals with intellectual and developmental disabilities. This experience can provide an opportunity for education and growth of social skills and basic life functions.

Elderly. Finding the right care for an aging family member can be a difficult decision to make. When there is an aging loved one with special medical needs in the family, it can take a toll on everyone. A group home is a great option for a more personalized care setting. In Florida, group homes offer medical care including transportation to health-related appointments. This setting also promotes socialization and a familiar cozy mood unlike the feel of a sterile nursing home. This can reduce the possibility of loneliness and depression.

Steps to Opening A Facility

Applicants will need to provide their licensing department with a business plan and operations manual along with the prospective location and community plan, geographical plan, zoning requirements, etc. Applicants may be eligible to receive Community Development Grant Block Funding to set up their home. Local community offices provide information on funding and assistance for group homes.

The Department of Children and Families licenses those homes for children under 19 years old without disabilities. In addition to the standard requirements, a group home for minors requires pre-approved menus from a licensed dietician, educational schedules, and daily activities.

The Agency for Health Care Administration is the licensing office for group homes with elderly and disabled patients.

The Department of Health frequently inspects homes unannounced to confirm the standard of living for residents. If the home assists with disabled persons, the Agency for Persons with Disabilities will also offer guidance and provide monthly monitoring visits to ensure that all requirements are met. Staff is usually rotated on a semi-monthly basis to maximize the efficiency of care. Depending on the type of home and number of patients, specialized permits and licensing may be required. Background checks on staffing is always required.

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It should be noted that I am not your lawyer (unless you have presently retained my services through a retainer agreement). This post is not intended as legal advice, it is purely educational and informational, and no attorney-client relationship shall result after reading it. Please consult your own attorney for legal advice. If you do not have one and would like to retain my legal services, please contact me using the contact information listed above.

 

All information and references made to laws, rules, regulations, and advisory opinions were accurate based on the law as it existed at this time, but laws are constantly evolving. Please contact me to be sure that the law which will govern your business is current. Thank you.

Florida LLC Conversion: Relocating a Business from another state to Florida

Transitioning out of state is a major business decision. As a business owner, there are usually numerous difficult decisions to be made with a permanent or long-term move. Not only can relocating your business to a different state be more convenient, but it can be beneficial for numerous reasons.

Benefits of Relocation

Some of the potential benefits include: (1) reduced or no state income taxes and (2) paying less for services or merchandise. Fortunately, in Florida the transition is not difficult. Another major benefit to conversion is that the company is allowed to maintain the original Tax ID. For an established company, maintaining the tax identification number (EIN number) is a major advantage because the company’s credit history can remain intact and any existing bank accounts can also remain active.

Difference between Conversion and Domestication

Florida allows for conversion of a business from another state. The terms ‘conversion’ and ‘domestication’ can be used interchangeably depending on the state you are in but there are a few differences that should be noted. The most notable difference is that conversion allows for a change in entity type.  Florida allows for LLCs to change the applicable governing law and convert into a Florida corporation (an S Corp). The company is then treated as though it was originally formed in Florida. This might provide tax benefits for the business owner. Domestication of a company merely allows for the company to relocate. In Florida, the term ‘domestication’ refers to the move of a company formed internationally into the state and is a more complex procedure.

Conversion Process in Florida

Conversion allows the business owner to only pay one set of fees (annual reports, renewal fees, etc). For the conversion to be acceptable, both states must allow conversion (or domestication). Terms and definitions can complicate the process slightly since every state behaves differently. Not all states allow conversion or domestication.

If allowed, the process and legal effects of Florida conversion are straightforward and nearly effortless. The filing fees are $150 and forms can be found on www.sunbiz.org. The company’s membership interests remain the same, any out-of-state property continues to be held by the company, and any debts also remain due by the company. The process of conversion permits the company to continue the day-to-day operations without any significant interruptions. Florida requires a Plan of Conversion which includes proposed Articles of Organization and Operating Agreements. Each member must consent in writing for the Plan of Conversion to be approved. After the plan of conversion is approved, members can file the Articles of Conversion with the Florida Division of Corporations.

Alternatives to Conversion

Alternatively, business owners can register as foreign LLC’s, dissolve the company and form a new company, or go through a merger in their new state if conversion is not allowed. However, these methods can be more costly and don’t have the added benefits previously mentioned.

It is recommended that an attorney assist with the process to ensure the forms are submitted accurately. At Jones Health law, we have experienced attorneys that can provide legal support during the conversion process.

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It should be noted that I am not your lawyer (unless you have presently retained my services through a retainer agreement). This post is not intended as legal advice, it is purely educational and informational, and no attorney-client relationship shall result after reading it. Please consult your own attorney for legal advice. If you do not have one and would like to retain my legal services, please contact me using the contact information listed above.

 

All information and references made to laws, rules, regulations, and advisory opinions were accurate based on the law as it existed at this time, but laws are constantly evolving. Please contact me to be sure that the law which will govern your business is current. Thank you.

Can a Florida Licensed Dental Hygienist Administer Anesthesia to Patients Without Supervision?

According to Florida Statute 466.023(1), Only dental hygienists may be delegated the task of removing calculus deposits, accretions, and stains from exposed surfaces of the teeth and from the gingival sulcus and the task of performing root planing and curettage. In addition, dental hygienists may expose dental X-ray films, apply topical preventive or prophylactic agents, and perform all tasks delegable by the dentist in accordance with s. 466.024. The board by rule shall determine whether such functions shall be performed under the direct, indirect, or general supervision of the dentist.
 
Section (3) of the aforementioned Florida Statute, states that dental hygienists may, without supervision, provide educational programs, faculty or staff training programs, and authorized fluoride rinse programs; apply fluorides; instruct a patient in oral hygiene care; supervise the oral hygiene care of a patient; and perform other services that do not involve diagnosis or treatment of dental conditions and that are approved by rule of the board.
 
Section (5) of the aforementioned Florida Statute, states that Dental hygienists may, without supervision, perform dental charting as provided in s. 466.0235.
 
Section (5) of the aforementioned Florida Statute, states thatA dental hygienist may administer local anesthesia as provided in ss. 466.017 and 466.024.
 
Florida Statute 466.017(4) states that A dentist or dental hygienist who administers or employs the use of any form of anesthesia must possess a certification in either basic cardiopulmonary resuscitation for health professionals or advanced cardiac life support approved by the American Heart Association or the American Red Cross or an equivalent agency-sponsored course with recertification every 2 years. Each dental office which uses any form of anesthesia must have immediately available and in good working order such resuscitative equipment, oxygen, and other resuscitative drugs as are specified by rule of the board in order to manage possible adverse reactions.
 
Florida Statute 466.017(5) states that a dental hygienist under the direct supervision of a dentist may administer local anesthesia, including intraoral block anesthesia, soft tissue infiltration anesthesia, or both, to a non-sedated patient who is 18 years of age or older, if the following criteria are met:
 
(a) The dental hygienist has successfully completed a course in the administration of local anesthesia which is offered by a dental or dental hygiene program accredited by the Commission on Dental Accreditation of the American Dental Association or approved by the board. The course must include a minimum of 30 hours of didactic instruction and 30 hours of clinical experience, and instruction in:
 
1. Theory of pain control.
2. Selection-of-pain-control modalities.
3. Anatomy.
4. Neurophysiology.
5. Pharmacology of local anesthetics.
6. Pharmacology of vasoconstrictors.
7. Psychological aspects of pain control.
8. Systematic complications.
9. Techniques of maxillary anesthesia.
10. Techniques of mandibular anesthesia.
11. Infection control.
12. Medical emergencies involving local anesthesia.
 
(b) The dental hygienist presents evidence of current certification in basic or advanced cardiac life support.
(c) The dental hygienist possesses a valid certificate issued under subsection (6).
 
According to Florida Statute 466.003(1)(8) “Direct supervision” means supervision whereby a dentist diagnoses the condition to be treated, a dentist authorizes the procedure to be performed, a dentist remains on the premises while the procedures are performed, and a dentist approves the work performed before dismissal of the patient.
 
According to Florida Statute 466.024(1)(l) A dentist may delegate remediable tasks to a dental hygienist or dental assistant when such tasks pose no risk to the patient. A dentist may only delegate remediable tasks so defined by law or rule of the board. The board by rule shall designate which tasks are remediable and delegable, except that administering local anesthesia pursuant to s. 466.017(5) is  by law found to be remediable and delegable.
 
https://open.spotify.com/episode/1zBgOvMS6VEwUOSvjJ30ls?si=13b4b36a23a84683
 
 

Florida Legal Requirements for an Adult Family Care Home

Adult Family Care Homes are Agency for Health Care Administration (“AHCA” or Agency) licensed facilities that provide care to disabled adults and frail elders in a family-type living environment. These adults choose to live with an individual or a family in a private home. One key distinction between an Assisted Living Facility and an Adult Family Care Home (“AFCH”) is that the Provider must also live in the home, which can be owned or rented by that Provider. The home has to meet the local zoning requirements prior to obtaining the AHCA license. The intent behind the Adult Family Care Home Act is to allow for residents of AFCHs to remain as independent as possible and to avoid placement in a nursing home or other licensed facility.

 

AFCH means a full-time, family-type living arrangement, in a private home, under which a person who owns or rents the home provides room, board, and personal care, on a 24-hour basis, for no more than five disabled adults or frail elders who are not relatives. Personal care services includes individual assistance with or supervision of the activities or daily living and the self-determination of medication, and other similar services. A resident who requires 24-hour nursing supervision may not be retained in an AFCH unless such resident is an enrolled hospice patient and the resident’s continued residency is mutually agreeable to the resident. Certain types of family-type living arrangements are not required to be licensed as an AFCH.

 

Although no more than five adults may reside in the home, the licensed maximum capacity of each AFCH is based on the service needs of the residents and the capability of the provider to meet the needs of the residents. Any relative who lives in the adult family-care home and who is a disabled adult or frail elder must be included in that maximum resident count.

 

AFCH Requirements and License Restrictions

AFCHs must designate at least one licensed space for a resident receiving optional state supplementation. AFCHs are required to provide all residents: (1) room and board; (2) assistance necessary to perform the activities of dialing living; (3) assistance necessary to administer medication; (4) supervision of residents; (5) health monitoring; and (6) social and leisure activities.

 

Each AFCH license is effective for 2 years from the date of issuance or renewal. These licenses are non-transferable and is valid only for the provider named, the capacity stated, and the premises described on the license.

 

AFCHs may advertise but these accommodations and services may not be listed in the yellow pages under the heading of “nursing home” or “assisted living facility”. The advertisement must include the term Adult Family-Care Home and the license number.

 

Resident Requirements

In order to be admitted as a resident of an AFCH, an individual must be: (1) at least 18 years of age; (2) free from apparent signs and symptoms of any communicable disease; (3) capable of self-preservation in an emergency situation involving the immediate evacuation of the AFCH, with ambulation; (4) be able to perform, with supervision or assistance, activities of daily living; (5) not be a danger to self or others; (6) not require licensed professional mental health treatment on a 24-hour a day basis; and (7) not be bedridden, to name a few.

 

Prior to admission to an AFCH, an individual must have a face-to-face medical examination conducted by a licensed healthcare provider. Every year thereafter, or after a significant change, the resident must have a face-to-face medical examination.

 

Prior to, or at the time of admission, the AFCH must provide the resident or their representative with the following: (1) a copy of the AFCH house rules; (2) Resident’s Bill of Rights, and (3) the procedure for making complaints to AHCA, the Department of Children and Families, or the Florida Department of Health.

 

Each resident has a statutorily defined Bill of Rights that the AFCH is required to adhere to. Some of these rights include: (a) living in a safe and decent living environment, free from abuse and neglect; (b) keep and use the resident’s own clothes and other personal property in the resident’s immediate living quarters, so as to maintain individuality and personal dignity; (c) unrestricted private communication, including receiving and sending unopened correspondence, having access to a telephone, and visiting with any person of his or her choice, at any time between the hours of 9 a.m. and 9 p.m. at a minimum; (d) management or resident’s own financial affairs; (e) share a room with the resident’s spouse if both are residents of the home; (f) exercise of civil and religious liberties; (g) access to adequate and appropriate healthcare; and (i) to be free from chemical and physical restraints.

 

Each resident must enter into a residency agreement with the provider, which is to be executed prior to or on the date of admission. The residency agreement must be kept on file for five years after expiration of the agreement. Additionally, each residency agreement must specify the personal care and accommodations to be provided by the AFCH, the rate or charges, a requirement of at least 30 days’ notice before a rate increase, and any other provisions required by AHCA or any other governing agency.

 

A resident shall not be discharged without 30 days’ written notice stating reasons for the move or transfer. The only exception to this written notice requirement is if the resident’s health requires immediate relocation; resident’s behavior poses an imminent danger to self or others, significantly interferes with the orderly operation of the home, or is continually offensive to other residents; or if the AFCH had its license denied, revoked, or voluntarily surrendered its license.

 

Provider Requirements

An AFCH Provider must bet at least 21 years old, live in the home, complete the required training and be able to read, write and complete written materials involved in applying for an AFCH license and maintaining an AFCH.

 

Each AFCH Provider must complete training and education programs. Training and education programs must include information relating to the appropriateness of placement of residents in an AFCH; identifying and reporting abuse, neglect, and exploitation; monitoring the health of residents and identifying and meeting the special needs of disabled adults and frail elders.

 

Conclusion

There are many other considerations that one must take into account when deciding to run an AFCH. An AFCH has certain personal services and supervision requirements, incident reporting requirements, health monitoring, food service and nursing services requirements, relief person and training requirements, records requirements, general requirements, fire safety standards, and emergency procedure requirements that were not addressed in this blog post but are critically important to operating your AFCH. If you are interested in operating an AFCH I would encourage you contact an experience health law attorney at Jones Health Law to assist you with navigating these requirements and others.

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It should be noted that I am not your lawyer (unless you have presently retained my services through a retainer agreement). This post is not intended as legal advice, it is purely educational and informational, and no attorney-client relationship shall result after reading it. Please consult your own attorney for legal advice. If you do not have one and would like to retain my legal services, please contact me using the contact information listed above.

 

All information and references made to laws, rules, regulations, and advisory opinions were accurate based on the law as it existed at this time, but laws are constantly evolving. Please contact me to be sure that the law which will govern your business is current. Thank you.

What are Advance Directives and how they work in Florida?

It’s not unusual for you or a family member to find oneself in a medical emergency where certain critical decisions pertaining to one’s health have to be made expediently. Often times people who are in emergency situations are incapacitated, whether due to legal incapacity (i.e. age), mental health or physical limitations, and are unable to make decisions for themselves. What ensues is a battle between loved ones about who has legal right to make certain decisions about your health. Out of nowhere comes an estranged spouse or distant relative who wants to make decisions that other family members feel they shouldn’t be making but are legally entitled to make. To avoid these scenarios, we encourage our clients to prepare advance directives. Florida Advance Directives are a combination of forms that are used in the event that an individual is physically or mentally incapable of giving consent. Individuals may complete an advance directive, which may include information about his or her living will, health care surrogates, and health care proxies. Each advance directive addresses medical and legal conditions that provide appropriate planned care to the individual.

 

Completing an Advance Directive

The following is a non-exhaustive list of the general principles of advance directives:

  • The individual completing a directive form must be a competent adult.
  • An advance directive completed in another state is applicable in Florida as long as it complies with the law of the state in which it was executed or with Florida law.
  • A competent adult may make an advance directive instructing their physician as to their wishes regarding their medical care, which may include instructions to provide, withhold, or withdraw life prolonging procedures.
  • A principal may empower a surrogate or health care proxy to make health care decisions for them on their advance directive.
  • The principal may amend or revoke an advance directive or the decisions of the health care surrogate or proxy at any time as long as the principal is competent.

 

Sections of Advance Directives in Florida

 

Living Will

Any competent adult may create a living will in respect to the principal’s desires regarding medical treatment should the principal become incompetent or incapacitated. The will must be signed by the principal in the presence of two witnesses. The witnesses cannot be the spouse or a blood relative of the principal. If the principal is physically unable to sign the will, a witness may subscribe the principal’s signature in the principal’s presence and direction as per Fla. Stat. §765.302. A living will may also be an oral statement made by the principal however the statute does not offer further guidance on how an oral living will is created.

 

Health Care Surrogate

Apart from living wills, an advance directive may consist of a health care surrogate. Florida allows a principal to appoint a person, such as a health care surrogate, to act as their healthcare decision maker. A healthcare surrogate must be a competent adult who has been designated by the principal, who must also be a competent adult, to make health care decisions on behalf of the principal. Unless the advance directive states a termination, the designations of the health care surrogate remain in effect unless revoked by the principal.

 

Health Care Proxy

A Health Care Proxy is a competent adult who has not been expressly designated by the principal to make health care decisions for them but is statutorily authorized in the event of the principal’s incapacity. In no particular order of priority, this is a non-exhaustive list of individuals who may act as a health care proxy for the principal:

  • The principals spouse
  • A judicially appointed guardian authorized to consent to medical treatment
  • An adult child
  • An adult sibling
  • A close personal friend of the principal
  • A license clinical social worker

 

End of Life Decisions Made through Living Will, Surrogate or Proxy

Florida law allows life-prolonging procedures to be withheld or withdrawn under the terms of a living will. As per Fla. Stat. §765.101(12), Florida defines life-prolonging procedures to include any medical procedure, treatment, or intervention, which sustains or supplants a spontaneous vital function. To determine whether life-prolonging procedures have to be withdrawn or withheld by a living will, surrogate, or proxy, the principal must be found to suffer from a terminal condition, end stage condition, or a persistent vegetative state. As per Fla. Stat. §765.304(1), the principal’s primary physician may proceed in life-prolonging procedures if the principal has not designated a surrogate to execute their wishes concerning life-prolonging procedures.

 

Do Not Resuscitate Order (DOH Form 1896)

There is a form drafted by the Florida Department of Health that is completed by a person’s physician to indicate that the person does not want to be resuscitated in case of a respiratory or cardiac arrest. In order for the form to be effective it must be printed on yellow paper. This form does not need to be witnessed and it does not require formalities. The principal or their health care surrogate/proxy and their physician must sign the form. Health care facilities and emergency responders will honor the DNRO form.

It should be clear why creating advance directives are essential and should become part of your estate planning. You do not want someone making decisions about your health care if you would prefer someone else to make those decisions on your behalf. Typically, if you select a certain individual to make decisions for you its because they are familiar with your wishes and would be willing to carry them out regardless of their own personal beliefs and emotional state. If you would like to learn more about advance directives, please feel free to contact one of our attorneys.

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It should be noted that I am not your lawyer (unless you have presently retained my services through a retainer agreement). This post is not intended as legal advice, it is purely educational and informational, and no attorney-client relationship shall result after reading it. Please consult your own attorney for legal advice. If you do not have one and would like to retain my legal services, please contact me using the contact information listed above.

 All information and references made to laws, rules, regulations, and advisory opinions were accurate based on the law as it existed at this time, but laws are constantly evolving. Please contact me to be sure that the law which will govern your business is current. Thank you.

Physician Assistants Scope of Practice Expansion in Florida

By: Arlette Rodriguez

Just as is the case with Advanced Practice Registered Nurses, the Florida Legislature has recognized that Physician Assistants (PA) are capable of performing certain health care activities that they were previously prohibited from performing. The changes are largely administrative and does not significantly increase the independent clinical services that they may provide to a patient. On June 29, 2021, the governor approved House Bill 431, which expands the scope of practice for Physician Assistants. The provisions set forth in the House Bill 431 took effect on July 1, 2021.

The following is a non-exhaustive list of some of the changes that PA can expect under the new law:

 

  • Prescribe psychiatric mental health-controlled substances to minors (under certain circumstances);
  • Supervise medical assistants;
  • Sign and certify documents that previously required a physician’s signature, such as Baker Act commitments, do-not-resuscitate orders, school physicals, and death certificates;
  • Bill directly to the insurance companies and receive payments for their provided services, and;
  • Authorize doctors to supervise up to ten physician assistants; (previously it was limited to four).

 

Notably, the law does not permit PA to sign for medical marijuana certification, workers compensation medical examinations required to determine maximum medical improvement, and impairment ratings. Florida PA are bound by the requirements contained in Florida Statute §§458.347 and 459.022.

One of the more noteworthy changes to the law is that it deletes the requirement that a physician assistant must inform his or her patients that they have the right to see a physician before the physician assistant prescribes or dispenses a prescription (amendment to Fla. Stat. §458.347(4)(e)(1)) and Fla. Admin. Code R. 64B8-30.012.  Also, physician assistants are now authorized to procure drugs and medical devices and revising the requirements for a certain formulary (amendment to Fla. Stat. §458.347(4)(f)(1) and Fla. Admin. Code R. 64B8-30.008).

 

Certificate of Completion of a Board Physician Assistant

Under the House Bill 431, a physician assistant applicant who has graduated after December 31, 2020 must have received a master’s degree in accordance with the Accreditation Review Commission on Education for the Physician Assistant. For an applicant who graduated on or before December 31, 2020, one must have received a bachelor’s or master’s degree from an approved program.

An applicant who graduated before July 1, 1994, must have graduated from an approved program of instruction in primary health care or surgery. An applicant who graduated before July 1, 1983, must have received a certification as a PA from the board.

Finally, the bill further authorizes the board to grant a license to an applicant who does not meet the above specified educational requirements, but who has passed the Physician Assistant National Certifying Examination administered by the National Commission on Certification of Physician Assistants before 1986.

The formulary changes in House Bill 431 will provide Physician Assistants the tools they need to reach a broader patient platform and by allowing doctors to supervise more physician assistants at a time, this will encourage hospitals and health care facilities to hire more physician assistants. House Bill 431 will bring many changes to physician assistants and we hope that you may benefit from these changes.

 

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It should be noted that I am not your lawyer (unless you have presently retained my services through a retainer agreement). This post is not intended as legal advice, it is purely educational and informational, and no attorney-client relationship shall result after reading it. Please consult your own attorney for legal advice. If you do not have one and would like to retain my legal services, please contact me using the contact information listed above.

 

All information and references made to laws, rules, regulations, and advisory opinions were accurate based on the law as it existed at this time, but laws are constantly evolving. Please contact me to be sure that the law which will govern your business is current. Thank you.

Can Florida Psychiatric Nurse Practitioners Register their Autonomous Practice for Primary Care Services?

Recently, the Board of Nursing voted to approve the following revised language for adoption by rule as the definition of “primary care practice”:

“Includes physical and mental health promotion, assessment, evaluation, disease prevention, health maintenance, counseling, patient education, diagnosis and treatment of acute and chronic illnesses, inclusive of behavioral and mental health conditions”.

This definition would be read in conjunction with Section 464.0123(3), Florida Statutes.

The Board also voted to accept the recommendation, also for adoption by rule, from the Council on APRN Autonomous Practice for “standards of practice” as:

“Advanced practice registered nurses who are registered pursuant to Section 464.0123, F.S., shall engage in autonomous practice only in a manner that meets the General Standard of Practice. The General Standard of Practice shall be that standard of practice, care, skill, and treatment which, in light of all relevant surrounding circumstances, is recognized as acceptable and appropriate by reasonably prudent similarly situated health care providers.”

 They don’t mention psychiatric nurse practitioners by name but the revised definition’s inclusion of words like “Mental health promotion, assessment, evaluation” and “treatment of….behavioral and mental health conditions” implies that this is inclusive of the services that a psychiatric NP would provide in a primary care setting.

We are awaiting further comment form the Board of Nursing with additional direction for the scope of services that psychiatric nurse practitioners can provide under this revised definition. I would argue that if the Board of Nursing approves your autonomous practice registration based on your description of providing psychiatric services that the BON is in turn permitting your to engage in autonomous practice for the provision of psychiatric nursing services in a primary care setting.

UPDATE (October 17, 2022): During an October 2022 Board Hearing, the Board of Nursing considered whether it is within the scope of practice for an autonomous practice APRN who is a psychiatric and mental health nurse practitioner to provide psychiatric and mental health treatment, including psychotherapy, to patients with psychiatric and mental health conditions. They also discussed whether it is within the scope of practice for an autonomous practice APRN to prescribe controlled substances under Section 893.03(2), F.S. for greater than a seven-day supply, for treatment for psychiatric and mental health conditions. Also, whether a supervising physician is needed to provide treatment, including psychotherapy, for psychiatric or mental health conditions. (Susan Patricia Lynch, APRN, R.N. – File#1711/304094 was the involved party)

The Florida Board of Nursing, after thoughtful deliberation and consideration of the law, answered “No”. The practice of an APRN, certified as a PMHNP, is not considered to be solely within the definition of primary care and as such, the PMHNP must still maintain a collaborative agreement. 

The BON asked for a continuance regarding the seven day supply of controlled substance class II medications to treat psychiatric mental health issues as the BON attorney wanted to research this subject further. This had not been considered formally by the BON since the passage of HB 607 authorizing a pathway for autonomous practice.

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