State regulatory update
Mary Thomas, Esq.
Special to the FMA
Protecting physicians and preserving physician-led care requires constant engagement in Florida’s evolving regulatory landscape. The FMA continues to closely monitor rulemaking, board actions, and policy discussions that directly affect physician practice and patient care across the state. Below is a summary of several key updates that Florida-licensed physicians should be aware of – from office surgery inspections to renewed scrutiny of APRN autonomous practice.
Rule Change: Office Surgery Inspections – Repeat Deficiencies
Throughout 2025, the Surgical Care and Quality Assurance Committee considered concerns related to repeat deficiencies identified during office surgery inspections. In many cases, registrants corrected deficiencies, such as incomplete crash cart supplies, only to be cited for the same issue during subsequent inspections. These recurring problems raised questions about accountability and the effectiveness of the current enforcement process.
Ultimately, the Board of Medicine and the Board of Osteopathic Medicine amended their respective rules related to office surgery inspections to allow the boards to take disciplinary action when an office does not appropriately implement a previous corrective action plan, resulting in a subsequent deficiency, as provided below:
Rules 64B9-9.0091(2)(e) and 64B15-14.0076(2)(e) , Florida Administrative Code
(2) Inspection.
…
(e) The deficiency notice and any subsequent documentation shall be reviewed for consideration of disciplinary action under any of the following circumstances below. However, nothing herein shall prevent the Board from considering disciplinary action when it is warranted by the particular facts and circumstances of the inspection, including evidence of repeated noncompliance regardless of the existence of a corrective action plan. :
1. No change.
2. When the initial notice of deficiencies contain deficiencies in the inspection immediately preceding the current inspection;
For physicians performing office-based surgery, this change underscores the importance of not only correcting cited deficiencies, but also ensuring those corrections are fully implemented, sustained, and documented over time. Repeat findings, particularly of issues tied to patient safety, expose an office and the designated physician to disciplinary action, even if a corrective action plan was previously submitted. Taking a proactive approach to compliance will be critical to avoiding repeat citations and demonstrating ongoing adherence to office surgery standards. This rule change is now in effect.
Revival of the Council on Advanced Practice Registered Nurse (APRN) Autonomous Practice
In 2020, the Florida Legislature approved autonomous practice for APRNs as a narrowly tailored solution to expand access to primary care in Florida’s rural and underserved communities. Fast forward a few years, and the results have raised serious concerns. There has been little to no evidence of APRNs migrating into rural primary care settings, while increasing reports suggest that many autonomous APRNs are practicing well beyond the limited primary care scope originally contemplated by lawmakers. Instead of expanding access to primary care services, APRN autonomous practice has too often translated to unsupervised practice in cash-pay med spas and aesthetic clinics – far removed from the legislative intent that was used to justify the policy in the first place.
The Board of Medicine recently reviewed evidence validating this widespread observation in “Autonomous nurse practitioners in Florida frequently practice outside their legal scope of primary care: a cross-sectional study ,” co-authored by FMA Treasurer Rebekah Bernard, MD. The study found substantial evidence that many autonomous APRNs in Florida have established specialty practices and are providing services that fall outside the primary care scope permitted under Florida law.
While the FMA has been successful before the Board of Nursing in intervening in petitions for declaratory statements filed by APRNs seeking to practice autonomously outside of primary care, there has been little recourse against those already operating beyond their legal scope without physician oversight and under what many view as an absence of meaningful enforcement.
In response, the Board of Medicine has called for the revival of the Council on APRN Autonomous Practice, which was originally created in 2020 with the passage of the autonomous practice legislation. The goal is to revisit and strengthen standards of practice, improve oversight, and ensure the law is implemented as intended.
The Council comprises two members from the Board of Medicine, two from the Board of Osteopathic Medicine, four from the Board of Nursing, and one member appointed by the state Surgeon General, who serves as chair. The Council is expected to convene for the first time in several years this summer.
The FMA will continue to closely monitor these developments and advocate for stronger guardrails that protect patients and preserve physician-led care.
Proposed Rule Change – Physician Assistant Supervision
At its April meeting, the Joint Boards of Medicine and Osteopathic Medicine’s Rules/Legislative Committee considered revisions to Rules
64B8-30.001 and
64B15-6.001 , F.A.C., which governs physician supervision of physician assistants, following concerns raised by the Joint Administrative Procedures Committee (JAPC) regarding the phrase “reasonable physical proximity” in the definition of indirect supervision.
JAPC identified the phrase as overly vague, noting that the rule did not clearly define what constitutes “reasonable” proximity for a supervising physician. In response, the Board agreed to strike the sentence, “The supervising physician must be within reasonable physical proximity,” from the definition of indirect supervision.
Rather than relying on a vague distance-based standard, the Board determined that supervision should continue to be evaluated under the broader “responsible supervision” framework already contained in Section (3) of the rule. That section defines supervision based on the supervising physician’s ability to responsibly exercise control and provide direction over the services of the physician assistant, with consideration given to several factors, including the complexity of the task, the risk to the patient, the physician assistant’s training and experience, the practice setting, the supervising physician’s availability, and the need for immediate attention.
Ultimately, this rule change should not have an impact on the standards for indirect supervision, as responsible supervision has always been a requirement.
Comprehensive Rules Review
Legislation passed in 2025 requires agencies to review at least 20 percent of their rules annually through 2030. As a result, the Rules and Legislative Committee reviewed several rules during its April 16, 2026, meeting that were either outdated, duplicative of statutory language, contained incorrect references, or otherwise required technical revisions.
None of the proposed changes are expected to impact practice standards and are included here for informational purposes. Please
click here for a list of changes.
For any questions on the regulatory activities impacting the practice of medicine, please contact
legal@flmedical.org or call (850) 224-6496.
Mary Thomas, Esq., is the Executive Director of the Council of Florida Medical School Deans. Previously, she served for over a decade as the Assistant General Counsel for the FMA. Ms. Thomas continues to represent the FMA in matters before the state's regulatory boards.