MOVING TO FLORIDA?
FAPA has received numerous emails from PAs around the country who are: planning to move to Florida; considering it; just want to do it; are in the process of doing it; their wife wants them to do it; their former boss wants them to do it; the kids want to live near Disney World; or some higher power told them to do it. After trying to answer all these emails in the past, Past President Ron Pace decided several years ago it was time to write the definitive article to answer all these questions. We grant you that this is a long article, but by reading it in its' entirety, you may save yourself time, needless phone calls, and worry. Many PAs before those reading this now have found it to be extremely useful in their move to Florida. We update it on a regular basis.
Most, if not all, of the answers can be found on the FAPA website. We have tried to design the site information layout so that with two or three clicks you can find out whatever you need to find out. We even have a site specific search engine to assist you finding information on the FAPA website. However, since many folks are still computer-challenged, have a computer phobia, or are simply not motivated enough to do it themselves and want someone else to do it for them, we have put together a comprehensive article outlining what you need to know if you are a PA and moving to the Sunshine State to practice. If after reading this article you still have questions, please contact us.
This article is designed to help those who were moving to Florida at some time. The FAPA website contains much more information in the FAQ section about practicing in Florida and we strongly suggesting review all the material offered in the sections. The questions found later in this document are not organized in any specific manner and that was intentional. We felt you would be more inclined to read them all that way rather than trying to find the specific information you are looking for and learn a few other things unintentionally. It is kind of like finding out important incidental information when you order a lab test or special procedure looking for one thing and finding out another. If the information is in this article, we thought it was kind of important for you to know.
The first thing you have to realize is that the southern medical folks are very conservative, and no where is this more true than here in Florida. As one advertising slogan used to proclaim, "The rules are different here." The PA practice rules in most southern states are not as liberal as elsewhere in the country. Look at the history. The southern states were among the last to grant prescribing privileges in general. Mississippi PAs just had a practice act enacted in recent years. Even in 2012 while the overwhelming majority of states now allow prescribing privileges for controlled medicines, Florida does not now nor will we in the foreseeable future. The Board of Medicine and the organized medical groups see that as an "increase in scope of practice" issue here and are not willing to grant us those privileges at this time. Also, the recent "pill mill crisis" has brought more attention to this issue and even physicians in Florida have more stringent regulations now on prescribing controlled medicinals. That is not to say the FAPA leadership does not continue to work diligently on this issue but it remains a very political issue and controversial for us here.
Some personal observations and comments from our years of experience here about the Florida licensure process:
As one of the more experienced PAs in Florida and one who receives hundreds of questions and emails about practice in Florida, Ron Pace would like to add this one very important piece of advice.
Now we will try to answer the routine questions we receive about practicing here in Florida.
A CME COURSE FROM FAPA
PA PRACTICE IN FLORIDA:
ABOUT THE CME PROGRAM
We strongly suggest that every PA applying for licensure, initial and renewal, download and study this material. It will be extremely beneficial to everyone. Keep the document copy handy at work, it will be a great information resource when you get questions from physicians, administrators or others about what you can and cannot do, and you will be able to quote them verbatim from the statutes and rules.
We hope you will find this course helpful to you in understanding PA practice statutes and rules here in Florida. We plan to update the course yearly as statutes and rules change. Between yearly updates notice of changes will be posted to the website and available from the FAPA office as well. It would be wise to consider taking the course with each license renewal cycle to make sure that one stays abreast of these changes. Remember, ignorance of the law is no excuse if you get in trouble down the line.
When should I call the Board of Medicine or PA Council?
The law provides that physician assistants (PAs) will now only be required to complete one (1) hour credit in HIV/AIDS – this must be done prior to the first renewal of the license, but once the physician assistant has taken one (1) credit, he or she does not ever have to take it again. Most Florida physician assistants have already met this requirement and will not need to take the course again.
The law provides that physician assistants (PAs) will now only be required to complete two (2) credits in Domestic Violence every six (6) years.
The HIV/AIDS and Domestic Violence courses will no longer be required prior to initial licensure. For initial licensure, the only requirement will be two (2) credits in Prevention of Medical Errors. The biennial requirement for Prevention of Medical Errors also remains the same – PAs must complete two (2) hours during each two-year licensure cycle.
Below is a summary of Florida CME requirements:
Two (2) credits in Prevention of Medical Errors
Every renewal thereafter:
If you ARE currently certified by NCCPA:
1. NCCPA certificate
2. Proof of completing a 2-hour course of category 1 or 2, Preventing Medical Errors
If you ARE NOT currently certified by NCCPA:
Proof of completing no less than ninety-six (98) category 1, general CME, plus
Proof of completing a 2-hour course of category 1 or 2, Preventing Medical Errors
Prescribing Physician Assistants:
1. In addition to the above, proof of completing 10 hours of CME in the specialty area of your supervising physician(s). The 10 hours is inclusive of the 98 general CME hours listed above.
2. 98 credit hours of CME including two (2) credits in Prevention of Medical Errors
In addition to the above, every third renewal must include:
Two (2) credits in Domestic Violence.
PAs renewing on January 31, 2008 will be required to complete two (2) credits of Domestic Violence before renewing on 2012.
Just a clarification point here, what we have known for years as Category I CME, and is now termed by the NCCPA as "Category (Preapproved) CME", and Category II CME is now "Category II (Elective) CME" for NCCPA certification purposes. The state regulations and rules still use the old Category I and Category II nomenclature.
Every two years Physician Assistants licensed in Florida must earn 100 total hours of CME. Florida law allows the NCCPA hours to count for the Florida required CME hours (just 100 total satisfies both entities). CME can be a combination of Category I and II. Full details of the requirements and logging are available from NCCPA at www.nccpa.net. The NCCPA recertification process is being revised now and over the next few years and we advise you to keep abreast of these changes through the NCCPA website.
If you maintain NCCPA certification, your NCCPA certificate is all the proof you need of the 100 general education hours provided you have proof of the specific hours required by the state as outlined below. But if audited by the state or NCCPA, you will need to be able to document all the hours.
As you hopefully know there are no specific required courses for the NCCPA certification or recertification; however, Florida does have some required courses that must be part of those 100 hours. In Florida, the first-time licensee applicants and new graduate PAs must certify with their license application that they have completed 1 hour of Domestic Violence, 1 hour of HIV/AIDS, and 2 hours of Medical Error Prevention. You certify that you have received these hours when you sign the application and must be able to provide documentation of course attendance if so requested. Graduates of Florida PA programs get these required hours in their education process here.
Included in the 100 total hours required, prescribing physician assistants must have 10 hours of Category I (Preapproved) CME in the area of specialty of your supervising physician for license renewal.
Category I (Preapproved) CME must be documented with a certificate of course completion/ attendance and remain on file in your personal records for SEVEN years and be available for audit review if so requested by the state. Fifty hours of Category I (Preapproved) are needed with at least 40 of them being clinically related. The remaining 10 can be non-clinical professional related.
Category II (Elective) CME is in optional categories and hours are obtained from medically related programs not otherwise eligible for Category I (Preapproved) CME credit. Some examples of CAT II (Elective) CME include the study of journals, pharmaceutical dinner presentations, reading medical textbooks, and reading medically related postgraduate course material that is NOT part of your PA program. As always, the regulatory source for what is to be considered Category I (Preapproved) or Category II (Elective) are the NCCPA guidelines.
The NCCPA makes it very easy to log your hours online now and if you log them as you earn them when renewal time comes around it is much easier to complete the process if you have done so. They even have a special feature to log hours obtained at AAPA National Conferences, and at FAPA state conferences as well.
There is a state mandate requiring certain health care professions to log their CME credits through an agency called CE Brokers. Logging your hours with CE Broker as an agent of the state is a voluntary action and PAs are not required to do so to maintain licensure. Do not be misled by the literature you may receive from CE Broker. Logging with them for a fee is still voluntary for physicians and PAs at this time. However providers of CME are required to file specified forms with the state contracted firm, CE Broker. This is an ongoing issue at this time and the final rules and regulations are under debate at this time. Watch the FAPA website for information on how this affects the PA profession. Reference: FAC 64B8-30.003 (4)(a); 64B8-30.005(2)(c-g) and (3)
FAPA offers the HIV, Medical Errors course and Domestic Violence courses at each of our semi-annual conferences.
Where can I get CME if I cannot wait for the next FAPA conference?
In the Knowledge Café section of this website is a section providing links to various CME Opportunities. You can do correspondence courses, lectures, other meetings. FAPA is only one source of hundreds of hours of available CME. Just make sure it is accredited CME acceptable to the NCCPA and you will be okay for the state requirements as well. The state required courses have to be approved by the state so before you take the course make sure it has been approved by the state as meeting their requirements.
What forms can I duplicate on a copier?
The application, the licensure verification form, and the PA program verification form can be copied, and Part B of the Prescriber license
What constitutes a separate employment location?
A separate business practice. (Example): A medical group name "pediatric consultants" with ten offices would be considered one employment setting with ten satellite offices. Two medical groups with five offices each would be considered two separate employment locations.
No. Verification of licensure must come directly to the board office from the source.
What if I can't find my original documents?
Obtain a duplicate from the source and submit a notarized statement explaining why you are unable to comply with this request.
Can supporting documentation be sent separately from the application to insure I have made the deadline date?
Yes. The application and application fee must be received by the deadline dates. The supporting documents can be mailed under separate cover.
What happens to the application if it's received a day or two after the deadline?
All applications are processed in date order as they are received in the board office. Upon completion, the application will be presented to the next available Council meeting.
Will the state accept a fax?
Yes, they can proceed with a fax copy as long as the fax is followed up with the original.
How long will it take to process my application?
The Council on Physician Assistants makes the determination on who will be licensed, however legislation passed in 2009 provides that no health care provider licensed by the state can be issued a licensed or have a licensed renewed if they have been convicted of a felony. The most recent interpretation of this law by the Department of Health provides:
1) A physician assistant applying for an initial license and did not receive it prior by July 1, 2009 will be governed by the provisions of the new law i.e. they will be denied a license if they have been convicted or pleaded nolo contendere to certain 3rd degree felonies in the past 15 years. These include Medicaid fraud, credit card fraud or drug convictions.
2) A physician assistant who currently has a license in Florida and is renewing will not be subject to this new law i.e. their license can be renewed. However, just as in the past, each professional board may discipline the individual for criminal convictions.
Can I be licensed as a temporary physician assistant even though I have taken the NCCPA exam?
Only those eligible to take the exam, but who have not yet taken and passed the NCCPA exam can obtain a temporary physician assistant license.
Is there an age limit to become a licensed physician assistant?
Yes. You must be 18 and older.
Can I work as a PA in Florida if I do not yet have a Florida license?
No, you must be licensed as a physician assistant or a temporary physician assistant prior to practicing as a PA in Florida.
What should I do if I have let my PA license lapse?
Apply for a license renewal as soon as possible. Make sure that you are working under direct supervision at all times until you have received your new license.
No, however you need to have passed the initial certification examination. But please note that most hospitals, managed care organizations, and insurance companies now require current NCCPA certification, and so it is usually wise to maintain current certification.
Which drugs are on the PA formulary?
Prescribing physician assistants are able to prescribe any medication except those specifically prohibited by the Formulary Committee of the PA Council and the Boards of Medicine. This is termed an Exclusionary Formulary.
Which drugs are excluded?
At present the medications that physician assistants are excluded from prescribing are controlled substances, general anesthetics, and radiographic contrast materials.
Are prescribing physician assistants required to keep a list of drugs that their supervising physician authorizes them to prescribe?
Yes. Even though we have an exclusionary formulary, other sections of the law and administrative code require each prescribing PA to have a list of medications the PA and the supervising physician agree that the PA may prescribe under the supervising physicians authority. It must be signed, dated, and maintained in the office for five years and available to DOH representatives upon request.
Can I join FAPA online?
Yes, you can join or renew your membership online and pay your annual dues as well. Click on the Membership tab on the homepage for forms and online
FAPA membership is on an annual basis from January 1st to December 31st of each calendar year. The FAPA office staff sends out renewals thru the mail in the last quarter of the calendar year. New members who join on or after October 1st of a calendar year receive full membership benefits for the rest of that year and the following calendar year as well, thus getting up to 15 months of membership benefits. If you sign up for the summer conference and join FAPA at the same time you get membership for the rest of that year PLUS the following calendar year.
What are the dues?
It depends on your membership category. Fellow, Associate, Affiliate dues are $185. Physician dues are $100. Military and Friendship dues are $50. Corporate dues are $500, and student dues are $50(covers the 2 yr. training period). Retired PAs dues are $50 but you cannot be working full time or part time in a paid PA position to be eligible for this category. The membership application has an explanation of each category of membership and can also be found in the Membership section on the website.
Why should I join FAPA?
Which drugs can a prescribing PA write prescriptions for at this time?
Prescribing privileges are granted to a PA working with a specific physician or physicians after you submit the properly completed application forms and letters. You may prescribe under their delegated authority while under their supervision. If you change supervising physicians you may not prescribe under your new supervising physician until you have submitted the proper forms to the state. Submitting the Change of Supervising Physician Data Form alone is NOT sufficient to prescribe under the new physician(s). You must submit a new application for change in prescribing privileges and a supervision physician data form with the new physician(s) within thirty days of the change.
How does changing a practice specialty affect prescribing privileges?
There is no longer a statutory requirement to have completed three months of supervision in a specialty after such a change in order to be granted privileges in that specialty. Again, you must still submit the properly completed application for change in prescribing privileges to that new specialty position. If you work in two different specialties, you have to complete an application for each setting, such as if you work in a Family Practice office and then work night or weekends in the Emergency Room.
How do I get prescribing rights?
For currently licensed non-prescribing PAs or Initial Applicants who want to become prescribers in Florida:
The physician assistant must ask their supervising physician if they will delegate that authority to the PA. If yes, then a supervising physician writes a letter to the DOH delegating that authority to the PA. The DOH has recommended they list the specialty, but it is not required by law. Listing the specialty will help down the line with the 10 hour specialty CME requirements.
Then, the PA writes a letter to the DOH requesting prescribing privileges and attaches the doctor's letter, and mails those letters to the DOH/PA Council. (It is advisable to send the letters certified, return receipt requested so that there is no question if the DOH received it.) The DOH after repeated review of the bill, agreed that only on initial licensure does a PA have to provide the course and transcript. They said they can't require anything for currently licensed PAs other than the request and delegation by their supervising physician.
Can I sign for sample medications received from pharmaceutical representatives?
Yes, if you have a prescribing license, but only for those medications you are authorized to prescribe.
Am I required to maintain a list of drugs that I prescribe?
F.A.C. 64B-300.007 and 64B15-6.0037 require that each supervising physician and prescribing physician assistant shall enter into and keep on file a written agreement outlining which of the medicinal drugs in the formulary that the supervising physician has specifically authorized the prescribing physician assistant to prescribe. It must be signed and dated by all parties and maintained on file for at least five years, and be available to responsible Department of Health personnel upon request.
Can I dispense medications?
PAs are allowed to dispense medications for a fee if they are Licensed Prescribing PAs who are being supervised by a physician who has dispensing privileges. Formulary laws still apply, so PAs may not dispense medications outside of their negative formulary.
No, as long as it is an approved drug on the formulary and included on your agreed upon list.
Do I have to keep duplicate copies of the prescriptions on file?
No. You must include notations in the medical record regarding the medications given the patient by you. It is recommended that you include in the note the name of the drug, strength, amount prescribed, specific directions, and refill instructions.
What information must be on the prescription form?
The prescription form may be preprinted. It must have the supervising physicians name, practice address, and phone number. It must have the physician assistant’s name and prescriber number on it also. If you work in a satellite office, or another practice setting, you will need to have a prescription form for each office or setting including all the required information.
Can PAs perform Florida Department of Law Enforcement physical examinations?
Yes. PAs can also perform the sports physicals for schools as well.
Can PAs sign the Application for Disabled Person Parking Permit Placard?
Yes. PAs are authorized to sign these application forms.
Florida law states that a physician is not required to cosign PA notations in medical records. The decision of how to best supervise a PA, however, lies with the supervising physician(s). Therefore they still have the right to require cosigning in their clinic or setting if that is their prerogative.
Are PAs required to have written protocols in order to practice?
If a physician assistant practices in a health department setting, the regulations set forth in F.S. 154.04(1)(c) apply to physician assistants and nurse practitioners in these specific settings. This statute requires written protocols for PAs and ARNPs in that setting. If you practice in any other setting you DO NOT need written protocols by state law. However, please be aware that some insurance companies, hospitals, physicians or other supervisory party may include protocols at their discretion. While restrictive, it is not illegal. Remember that responsible parties, credentialing agencies, and other supervisory parties cannot do LESS than the law requires, but they may place other restrictions as part of the job limitations or requirements. Most employers will not want to put any more limitations on your practice than are required by law.
Is there a state law regarding reimbursement for PAs in surgical first assisting?
Yes. Chapter 627.419, paragraph (6) of Title XXXVII relating to Insurance Rates and Contracts provides for reimbursement of physician assistants who are assisting in surgery. On the homepage of the FAPA website is a link to "Reimbursement Information" and if you have questions in that area you may find the answers there. If you have questions that were not answered above, please contact us.
What are the state laws in regards to notifying patients of my credentials as Physician Assistant?
All health care licensees must provide notice to patients of what type of license the health care provider has (e.g., Medical Doctor, ARNP, Physician Assistant, Dentist, etc):
The following apply only to satellite offices offering primarily dermatologic or skin care services, which include, aesthetic skin care services other than plastic surgery:
We believe that this article should answer about 99% of your questions, but if you still have questions, just call or email us and we will do our best to assist you. We sincerely want your move to Florida and the licensure process to be as painless as possible.
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