HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: CS/CS/HB 431 Practice of Physician Assistants
SPONSOR(S): Health & Human Services Committee, Professions & Public Health Subcommittee, Rommel
TIED BILLS: IDEN./SIM. BILLS:
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF
1) Professions & Public Health Subcommittee 17 Y, 1 N, As CS Rahming McElroy
2) Health & Human Services Committee 15 Y, 3 N, As CS Rahming Calamas
SUMMARY ANALYSIS
Physician Assistants (PAs) are regulated by the Florida Council on Physician Assistants in conjunction with
either the Board of Medicine for PAs licensed under ch. 458, F.S., or the Board of Osteopathic Medicine for
PAs licensed under ch. 459, F.S.
CS/CS/HB 431 revises the practice acts for PAs in chs. 458 and 459. The bill:
Specifies which PA education and training programs are approved for PA licensure and amends PA
licensure and licensure renewal requirements;
Authorizes PAs to authenticate any document with their signature, certification, stamp, verification,
affidavit, or endorsement if the document may also be authenticated by a physician’s signature,
certification, stamp, verification, affidavit or endorsement;
Removes the prohibition on PAs prescribing psychiatric medications for those under 18 years of age;
Removes the restriction on the number of licensed PAs a physician may supervise at any one time;
Removes the requirement that a PA notify a patient that he or she has the right to see a physician prior
to the PA prescribing or dispensing a prescription;
Authorizes PAs to procure medications and medical devices, with exceptions;
Authorizes PAs to supervise allopathic and osteopathic medical assistants;
Authorizes PAs to directly bill and receive payment from third-party payors for the services they deliver;
The bill repeals authorization for the DOH to issue prescriber numbers;
Removes the requirement for a licensed PA to notify the DOH in writing within 30 days of employment
or after any change in his or her supervising physician; and
Removes the requirement that PA licensure applicants seeking prescribing authority provide course
transcripts.
The bill has an insignificant, negative fiscal impact on the DOH, which can be absorbed within current
resources. The bill has no fiscal impact on local governments.
The bill provides an effective date of July 1, 2021.
This document does not reflect the intent or official position of the bill sponsor or House of Representatives .
STORAGE NAME: h0431b.HHS
DATE: 4/7/2021
FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Current Situation
Physician Assistants
Physician Assistants (PAs) are regulated by the Florida Council on Physician Assistants (Council) in
conjunction with either the Board of Medicine for PAs licensed under ch. 458, F.S., or the Board of
Osteopathic Medicine for PAs licensed under ch. 459, F.S.
Council on Physician Assistants
The Council consists of five members including one physician who is a member of the Board of
Medicine, one physician who is a member of the Board of Osteopathic Medicine, and three licensed
PAs appointed by the Surgeon General.1 The appointed physicians must be physicians who supervise
physician assistants in their practice. The Council is responsible for:2
Making recommendations to the DOH regarding the licensure of PAs;
Developing rules for the regulation of PAs for consideration for adoption by the boards;
Making recommendations to the boards regarding all matters relating to PAs;
Addressing concerns and problems of practicing PAs to ensure safety in the PAs’ clinical
practices;
Denying, restricting, or placing conditions on the license of PAs who fail to meet the licensing
requirements; and
Establishing a formulary of medicinal drugs that PAs may not prescribe.3
Licensure and Regulation of PAs
An applicant for a PA license must apply to the DOH, and the DOH must issue a license to a person
certified by the Council as having met all of the following requirements:4
Is at least 18 years old;
Completed the application form and paid the applicable application fee;
Acknowledged any prior felony convictions;
Acknowledged any previous revocation or denial of licensure in any state;
Provided a copy of course transcripts and a copy of the course description from a PA training
program describing the course content in pharmacotherapy, if the applicant is seeking
prescribing authority; and
Submitted to a background screening and have no disqualifying offenses.5
Current law also requires PA licensure applicants to obtain a passing score on “an entry-level
examination approved by the boards, including, but not limited to, those examinations administered by
the National Commission on Certification of Physician Assistants.” However, since there are no
subsequent PA advancing examinations, “entry-level examination” is a misnomer. Instead, PA
licensure applicants must specifically pass the Physician Assistant National Certifying Examination
1 Ss. 458.347(9) and 459.022(9), F.S. Members of the Board of Medicine and the Board of Osteopathic Medicine are appointed by the
Governor and confirmed by the Senate. See ss. 458.307 and 459.004, F.S., respectively.
2 Id.
3 S. 458.347(4)(f), F.S.
4 Ss. 458.347(7) and 459.022(7), F.S.
5 S. 456.0135, F.S.
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(PANCE) administered by the National Commission on Certification of Physician Assistants to obtain
PA licensure.6
The DOH may issue a temporary license to a recent approved program graduate who expects to take
the first National Commission on Certification of Physician Assistants administered examination
available for registration after the applicant’s graduation.7 If an applicant has completed all licensure
requirements and is awaiting the next scheduled meeting of the Council, the DOH may issue up to two
temporary licenses to practice.8 The temporary license expires 30 days after an applicant receives his
or her scores of the proficiency examination and authorizes an applicant who has passed the
examination to be granted permanent licensure.9 Applicants who fail the examination can no longer
hold a temporary license, unless they reapply for a 1-year extension of the temporary license.10
Within 30 days after gaining employment as a PA, licensed PAs must provide written notice with
specified information to the DOH or after any subsequent changes in the supervising physician. PAs
must renew their licenses biennially. During each biennial renewal cycle PAs must complete 100 hours
of continuing medical education (CME) or must demonstrate current certification issued by the National
Commission on Certification of Physician Assistants.11 To maintain certification, PAs must also take a
recertification examination every 10 years.12
PA Education
PA education programs are typically three years and award master’s degrees.13 Many programs
require students to have health care experience as a condition for admission.14 PA students receive
classroom training in:15
Anatomy;
Physiology;
Biochemistry;
Pharmacology;
Physical diagnosis;
Pathophysiology;
Microbiology;
Clinical laboratory science;
Behavioral science; and
Medical Ethics.
A PA student must also complete approximately 2,000 hours of clinical rotations, with an emphasis on
primary care in ambulatory clinics, physician offices, and acute or long-term care facilities.16 A PA
student’s rotation could also include family medicine, internal medicine, obstetrics and gynecology,
pediatrics, general surgery, emergency medicine, or psychiatry.17
Currently, PA licensure requires completion of an education and training program accredited by the
Commission on Accreditation of Allied Health Programs (CAAHP) or its successor organization.18 The
6 American Academy of PAs, Become a PA, https://www.aapa.org/career-central/become-a-
pa/#:~:text=Once%20you've%20graduated%20from,of%20Physician%20Assistants%20(NCCPA) (last visited Apr. 6, 2021).
7 Ss. 458.347(7) and 459.022(7), F.S.
8 Id.
9 Id.
10 Id.
11 Ss. 458.347(7)(c) and 459.022(7)(c), F.S.
12 National Commission on Certification of Physician Assistants, Maintaining Certification, https://www.nccpa.net/CertificationProcess
(last visited Feb. 15, 2021).
13 American Academy of PAs, Become a PA, https://www.aapa.org/career-central/become-a-pa/ (last visited Feb. 15, 2021).
14 Id.
15 Id.
16 Id.
17 Id.
18 Ss. 458.347(6) and 469.022(6), F.S.
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CAAHP, a 501(c)(3) tax exempt organization formed in 1994, is a programmatic postsecondary
accrediting agency recognized by the Council for Higher Education Accreditation and carries out its
accrediting activities in cooperation with 25 review Committees on Accreditation.19 However, the
CAAHP no longer accredits PA education and training programs.20
Since 2001, the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA),
has been the accrediting agency that defines the standards for PA education and evaluates PA
educational programs to ensure their compliance with those standards within the territorial United
States.21 Only graduates of PA degree programs certified by the ARC-PA are eligible to take the
PANCE.22
The current statutory reference to CAAHP is obsolete; however, the statutory reference to CAAHP’s
successor organization as an alternative prevents any harm from this obsolesce.
PA Supervision
PAs may only practice under the direct or indirect supervision of an allopathic or osteopathic physician
with whom they have a clinical relationship.23 A supervising physician may only delegate tasks and
procedures to the PA that are within the supervising physician’s scope of practice.24 The supervising
physician may not supervise more than four PAs at any time and may not be required to review and
cosign charts or medical records prepared by a PA under their supervision.25 The supervising physician
is also responsible and liable for any acts or omissions of the PA.26
The Boards have established by rule that “responsible supervision” of a PA means the ability of the
supervising physician to responsibly exercise control and provide direction over the services of the PA.
Whether the supervision of a PA is adequate, is dependent upon the: 27
Complexity of the task;
Risk to the patient;
Background, training, and skill of the PA;
Adequacy of the direction in terms of its form;
Setting in which the tasks are performed;
Availability of the supervising physician;
Necessity for immediate attention; and
Number of other persons that the supervising physician must supervise.
A supervising physician decides whether to permit a PA to perform a task or procedure under direct or
indirect supervision28 based on reasonable medical judgment regarding the probability of morbidity and
mortality to the patient.29
19 Commission on Accreditation of Allied Health Education Programs, Committees on Accreditation, https://www.caahep.org/About-
CAAHEP/Committees-on-Accreditation.aspx (lst visited Apr. 5, 2021).
20 Id.
21 Accreditation Review Commission on Education for the Physician Assistant, Inc., Accreditation Review Commission on Education for
the Physician Assistant, http://www.arc-pa.org/about/arc-pa-history/ (last visited Apr. 5, 2021).
22 National Commission on Certification of Physician Assistants, PANCE Eligibility Requirements, https://www.nccpa.net/pance-
eligibility (last visited Apr. 6, 2021).
23 Ss. 458.347(2)(f) and 459.022(2)(f), F.S., define supervision as responsible supervision and control which requires the easy
availability or physical presence of the licensed physician for consultation and direction of the PA.
24 Rr. 64B8-30.012 and 64B15-6.010, F.A.C.
25 Ss. 458.347(3) and 459.022(3), F.S.
26 Ss. 458.347(15) and 459.022(15), F.S.
27 Rr. 64B8-30.001, F.A.C., and 64B15-6.001, F.A.C.
28 “Direct supervision” refers to the physical presence of the supervising physician so that the physician is immediately available to the
PA when needed. “Indirect supervision” refers to the easy availability of the supervising physician to the physician assistant, which
includes the ability to communicate by telecommunications. The supervising physician must be within reasonable physical proximity.
See Rr. 64B8-30.001, F.A.C., and 64B15-6.001, F.A.C.
29 Rr. 64B8-30.012(2), F.A.C., and 64B15-6.010(2), F.A.C.
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Unlike physicians, PAs are not currently authorized to authenticate any document with their signature,
certification, stamp, verification, affidavit, or endorsement.
Current law does not expressly regulate whether PAs may directly bill for and receive direct payment
for their delivered services, rather than the supervising physician or employer. Currently, third-party
payors may choose to reimburse PA employers for PA-rendered covered services.30
PA Prescribing
A supervising physician may delegate the authority for a PA to prescribe or dispense any medication
used in the supervising physician’s practice, or medication for administration to the supervising
physician’s patient in a hospital or other facility licensed under ch. 395, F.S., or a nursing homes
licensed under part II of ch. 400, F.S.31
However, physician may not delegate the authority for a PA to prescribe medication listed in a
formulary established by the Council.32 The formulary prohibits PAs from prescribing general, spinal, or
epidural anesthetics; radiographic contrast materials; and psychiatric mental health controlled
substances for children younger than 18 years of age.33 It also restricts the prescribing of Schedule II
controlled substances to a 7-day supply.34
For a PA to prescribe or dispense medication, the supervising physician must notify the DOH of the
intention to delegate such authority and the PA must complete a minimum of 10 CME hours in the
specialty practice in which the PA has prescriptive privileges with each licensure renewal. Three of the
10 CME hours that allopathic PAs are required to take must consist of a continuing education course
on the safe and effective prescribing of specified controlled substances. 35 Under current law,
osteopathic PAs are not required to take courses on the safe and effective prescribing of controlled
substances. In addition, before prescribing, the PA must notify the patient that he or she has the right to
see a physician prior to prescribing or dispensing a prescription.
Prescribing practitioners, including PAs, must register with the federal Drug Enforcement
Administration.36 Current law authorizes the DOH to issue a prescriber number to the PA granting
authority to prescribe medicinal drugs, which creates a presumption that the PA is authorized to
prescribe the medicinal drug and the prescription is valid. 37 However, the DOH does not issue
prescriber numbers; instead, the DOH chooses to place a modifier on the PA’s license so that its
license verification page indicates the practitioner is an authorized prescribing PA.38
PA Adverse Incident Reporting
A PA must report to the DOH any adverse incident occurring in an office practice setting within 15 days
after the occurrence of the adverse incident.39
An adverse incident in an office setting is defined as an event over which the PA could exercise control
and which is associated with a medical intervention and results in one of the following patient injuries:40
30 Ss. 458.347(4)(b) and 459.022(4)(b), F.S.
31 Ss. 459.347(4)(f) and 459.022(4)(f), F.S. Chapter 395, F.S., provides for the regulation and the licensure of hospitals and trauma
centers, part II of ch. 400, F.S., provides for the regulation and licensure of nursing home facilities.
32 Ss. 458.347(4)(f) and 459.022(4)(f), F.S
33
Rr. 64B8-30.008 and 64B15-6.0038, F.A.C
34 Id.
35 Ss. 458.347(4)(e) and 459.022(4)(e), F.S.
36 21 U.S.C. 822(a)(2).
37 Ss. 459.347(4)(e) and 459.022(4)(e), F.S.
38 Email from Andrew Love, Director of Legislative Affairs, Florida Department of Health, RE: HB 4