Signed by Governor Ron DeSantis

Vote Smart's Synopsis:

Vote to amend and pass a bill that authorizes nurse practitioners to open primary care practices without doctor supervision.

Highlights:

• Establishes within the agency the Excellence in Home Health Program for the purpose of awarding home health agencies that, at minimum, meet standards related to (Sec. 9):

• Patient satisfaction;

• Patients requiring emergency care for wound infections;

• Patients admitted or readmitted to an acute care hospital;

• Patient improvement in the activities of daily living;

• Employee satisfaction;

• Quality of employee training;

• Employee retention rates; and

• High performance under federal Medicaid electronic visit verification requirements.

• Establishes within the agency the Nurse Registry Excellence Program for the purpose of awarding nurse registries that, at minimum, meet standards relating to (Sec. 10):

• Patient or client satisfaction;

• Patients or clients requiring emergency care for wound infections;

• Patients or clients admitted or readmitted to an acute care hospital;

• Patient or client longevity with the nurse registry;

• Independent contractor satisfaction;

• Independent contractor longevity with the nurse registry; and

• High performance under federal Medicaid electronic visit verification requirements.

• Authorizes a registered nurse to delegate a task to a certified nursing assistant or home health aide if the registered nurse determines that the certified nursing assistant or the home health aide is competent to perform the task, the task is delegable under federal law, and the task meets the following criteria (Sec 12):

• Is within the nurse's scope of practice;

• Frequently recurs in the routine care of a patient or group of patients;

• Is performed according to an established sequence of steps;

• Involves little or no modification from one patient to another;

• May be performed with a predictable outcome;

• Does not inherently involve ongoing assessment, interpretation, or clinical judgment; and

• Does not endanger a patient's life or well-being.

• Defines “autonomous practice” as an advanced nursing practice by an advanced practice registered nurse and who is not subject to supervision by a physician or a supervisory protocol (Sec. 21).

• Requires the board to register an advanced practice registered nurse as an autonomous advanced practice registered nurse if the applicant demonstrates that they (Sec. 24):

• Hold an active, unencumbered license to practice advanced nursing;

• Have not been subject to any disciplinary action or any similar disciplinary action in another state or other territory or jurisdiction within the 5 years immediately preceding the registration request;

• Have completed, in any state, jurisdiction, or territory of the United States, at least 3,000 clinical practice hours within the 5 years immediately preceding the registration request while practicing as an advanced practice registered nurse under the supervision of an allopathic or osteopathic physician who held an active, unencumbered license issued by any state, jurisdiction, or territory of the United States during the period of such supervision; and

• Have completed within the past 5 years 3 graduate-level semester hours, or the equivalent, in differential diagnosis and 3 graduate-level semester hours, or the equivalent, in pharmacology.

• Specifies that the board may provide additional registration requirements by rule (Sec. 24).

• Requires an advanced practice registered nurse registered under this section, with some exceptions, to demonstrate to the satisfaction of the board and the department financial responsibility to pay claims and costs ancillary thereto arising out of the rendering of, or the failure to render nursing care, treatment, or services (Sec. 24).

• Authorizes an advanced practice registered nurse who is registered under this section to (Sec. 24):

• Engage in autonomous practice only in primary care practice, including family medicine, general pediatrics, and general internal medicine, as defined by board rule;

• For certified nurse midwives, engage in autonomous practice in the performance of certain acts;

• Perform the general functions of an advanced practice registered nurse related to primary care;

• For a patient who requires the services of a health care facility:

• Admit the patient to the facility;

• Manage the care received by the patient in the facility; and

• Discharge the patient from the facility, unless prohibited by federal law or rule; and

• Provide a signature, certification, stamp, verification, affidavit, or endorsement that is otherwise required by law to be provided by a physician.

• Establishes the Council on Advanced Practice Registered Nurse Autonomous Practice within the Department of Health (Sec. 24).

• Requires an advanced practice registered nurse to biennially renew registration under this section (Sec. 24).

• Requires an advanced practice registered nurse registered under this section to provide information in writing to a new patient about their qualifications and the nature of autonomous practice before or during the initial patient encounter when engaging in autonomous practice (Sec. 24).

• Prohibits a health insurance policy that provides major medical coverage and that is delivered, issued, or renewed in the state on or after January 1, 2021, from requiring an insured person to receive services from an advanced practice registered nurse in place of a physician (Sec. 28).

• Requires the Department of Health to make payments of up to $15,000 per year to advanced practice registered nurses who demonstrate, as required by department rule, active employment providing primary care services in a public health program, independent practice or a group practice that serves Medicaid recipients and other low-income patients and that is located in a primary care health professional shortage area (Sec. 43).

• Appropriates $5 million in recurring funds for the 2020-2021 fiscal year to the Department of Health for the Health Care Education Reimbursement and Loan Repayment Program for advanced practice registered nurses registered to engage in the autonomous practice (Sec. 44).

Full Bill Text