1     
MEDICAL SCHOOL GRADUATES ASSOCIATE PHYSICIAN

2     
LICENSURE

3     
2017 GENERAL SESSION

4     
STATE OF UTAH

5     
Chief Sponsor: Stewart E. Barlow

6     
Senate Sponsor: Brian E. Shiozawa

7     Cosponsors:
8     Susan Duckworth
9     Stephen G. Handy
10     Sandra Hollins
Michael S. Kennedy
Paul Ray
Edward H. Redd
Douglas V. Sagers
Scott D. Sandall
Robert M. Spendlove
11     

12     LONG TITLE
13     General Description:
14          This bill creates a restricted license enabling a medical school graduate to practice
15     medicine under certain conditions.
16     Highlighted Provisions:
17          This bill:
18          ▸     defines terms;
19          ▸     creates the restricted associate physician license;
20          ▸     describes licensure requirements;
21          ▸     describes the scope of practice of a restricted associate physician license;
22          ▸     permits a qualified physician to enter into a cooperative practice arrangement with a
23     licensed associate physician;
24          ▸     describes a cooperative practice arrangement;
25          ▸     requires the Division of Occupational and Professional Licensing to make rules
26     regarding:
27               •     the approval of cooperative practice arrangements; and
28               •     educational methods and programs for associate physicians; and

29          ▸     makes technical changes.
30     Money Appropriated in this Bill:
31          None
32     Other Special Clauses:
33          This bill provides a special effective date.
34     Utah Code Sections Affected:
35     AMENDS:
36          58-67-102, as last amended by Laws of Utah 2013, Chapter 262
37          58-67-303, as last amended by Laws of Utah 2011, Chapter 206
38          58-67-304, as last amended by Laws of Utah 2011, Chapters 161 and 214
39          58-67-502, as last amended by Laws of Utah 2015, Chapters 110 and 206
40          58-67-601, as last amended by Laws of Utah 2013, Chapter 364
41          58-68-102, as last amended by Laws of Utah 2013, Chapter 262
42          58-68-303, as last amended by Laws of Utah 2005, Chapter 94
43          58-68-304, as last amended by Laws of Utah 2011, Chapters 161 and 214
44          58-68-502, as last amended by Laws of Utah 2015, Chapters 110 and 206
45          58-68-601, as last amended by Laws of Utah 2013, Chapter 364
46     ENACTS:
47          58-67-302.8, Utah Code Annotated 1953
48          58-67-807, Utah Code Annotated 1953
49          58-68-302.5, Utah Code Annotated 1953
50          58-68-807, Utah Code Annotated 1953
51     

52     Be it enacted by the Legislature of the state of Utah:
53          Section 1. Section 58-67-102 is amended to read:
54          58-67-102. Definitions.
55          In addition to the definitions in Section 58-1-102, as used in this chapter:
56          (1) "Ablative procedure" means a procedure that is expected to excise, vaporize,

57     disintegrate, or remove living tissue, including the use of carbon dioxide lasers and erbium:
58     YAG lasers, and excluding hair removal.
59          (2) "ACGME" means the Accreditation Council for Graduate Medical Education of the
60     American Medical Association.
61          (3) "Administrative penalty" means a monetary fine or citation imposed by the division
62     for acts or omissions determined to constitute unprofessional or unlawful conduct, in
63     accordance with a fine schedule established by the division in collaboration with the board, as a
64     result of an adjudicative proceeding conducted in accordance with Title 63G, Chapter 4,
65     Administrative Procedures Act.
66          (4) "Associate physician" means an individual licensed under Section 58-67-302.8.
67          [(4)] (5) "Board" means the Physicians Licensing Board created in Section 58-67-201.
68          (6) "Collaborating physician" means an individual licensed under Section 58-67-302
69     who enters into a collaborative practice arrangement with an associate physician.
70          (7) "Collaborative practice arrangement" means the arrangement described in Section
71     58-67-807.
72          [(5)] (8) (a) "Cosmetic medical device" means tissue altering energy based devices that
73     have the potential for altering living tissue and that are used to perform ablative or nonablative
74     procedures, such as American National Standards Institute (ANSI) designated Class IIIb and
75     Class IV lasers, intense pulsed light, radio frequency devices, and lipolytic devices, and
76     excludes ANSI designated Class IIIa and lower powered devices.
77          (b) Notwithstanding Subsection [(5)] (8)(a), if an ANSI designated Class IIIa and lower
78     powered device is being used to perform an ablative procedure, the device is included in the
79     definition of cosmetic medical device under Subsection [(5)] (8)(a).
80          [(6)] (9) "Cosmetic medical procedure":
81          (a) includes the use of cosmetic medical devices to perform ablative or nonablative
82     procedures; and
83          (b) does not include a treatment of the ocular globe such as refractive surgery.
84          [(7)] (10) "Diagnose" means:

85          (a) to examine in any manner another person, parts of a person's body, substances,
86     fluids, or materials excreted, taken, or removed from a person's body, or produced by a person's
87     body, to determine the source, nature, kind, or extent of a disease or other physical or mental
88     condition;
89          (b) to attempt to conduct an examination or determination described under Subsection
90     [(7)] (10)(a);
91          (c) to hold oneself out as making or to represent that one is making an examination or
92     determination as described in Subsection [(7)] (10)(a); or
93          (d) to make an examination or determination as described in Subsection [(7)] (10)(a)
94     upon or from information supplied directly or indirectly by another person, whether or not in
95     the presence of the person making or attempting the diagnosis or examination.
96          [(8)] (11) "LCME" means the Liaison Committee on Medical Education of the
97     American Medical Association.
98          [(9)] (12) "Medical assistant" means an unlicensed individual working under the
99     indirect supervision of a licensed physician and surgeon and engaged in specific tasks assigned
100     by the licensed physician and surgeon in accordance with the standards and ethics of the
101     profession.
102          (13) "Medically underserved area" means a geographic area in which there is a
103     shortage of primary care health services for residents, as determined by the Department of
104     Health.
105          (14) "Medically underserved population" means a specified group of people living in a
106     defined geographic area with a shortage of primary care health services, as determined by the
107     Department of Health.
108          [(10)] (15) (a) (i) "Nonablative procedure" means a procedure that is expected or
109     intended to alter living tissue, but is not intended or expected to excise, vaporize, disintegrate,
110     or remove living tissue.
111          (ii) Notwithstanding Subsection [(10)] (15)(a)(i), nonablative procedure includes hair
112     removal.

113          (b) "Nonablative procedure" does not include:
114          (i) a superficial procedure as defined in Section 58-1-102;
115          (ii) the application of permanent make-up; or
116          (iii) the use of photo therapy and lasers for neuromusculoskeletal treatments that are
117     performed by an individual licensed under this title who is acting within the individual's scope
118     of practice.
119          [(11)] (16) "Physician" means both physicians and surgeons licensed under Section
120     58-67-301, Utah Medical Practice Act, and osteopathic physicians and surgeons licensed under
121     Section 58-68-301, Utah Osteopathic Medical Practice Act.
122          [(12)] (17) (a) "Practice of medicine" means:
123          (i) to diagnose, treat, correct, administer anesthesia, or prescribe for any human
124     disease, ailment, injury, infirmity, deformity, pain or other condition, physical or mental, real
125     or imaginary, including to perform cosmetic medical procedures, or to attempt to do so, by any
126     means or instrumentality, and by an individual in Utah or outside the state upon or for any
127     human within the state;
128          (ii) when a person not licensed as a physician directs a licensee under this chapter to
129     withhold or alter the health care services that the licensee has ordered;
130          (iii) to maintain an office or place of business for the purpose of doing any of the acts
131     described in Subsection [(12)] (17)(a) whether or not for compensation; or
132          (iv) to use, in the conduct of any occupation or profession pertaining to the diagnosis or
133     treatment of human diseases or conditions in any printed material, stationery, letterhead,
134     envelopes, signs, or advertisements, the designation "doctor," "doctor of medicine,"
135     "physician," "surgeon," "physician and surgeon," "Dr.," "M.D.," or any combination of these
136     designations in any manner which might cause a reasonable person to believe the individual
137     using the designation is a licensed physician and surgeon, and if the party using the designation
138     is not a licensed physician and surgeon, the designation must additionally contain the
139     description of the branch of the healing arts for which the person has a license, provided that an
140     individual who has received an earned degree of doctor of medicine degree but is not a licensed

141     physician and surgeon in Utah may use the designation "M.D." if it is followed by "Not
142     Licensed" or "Not Licensed in Utah" in the same size and style of lettering.
143          (b) The practice of medicine does not include:
144          (i) except for an ablative medical procedure as provided in Subsection [(12)]
145     (17)(b)(ii), the conduct described in Subsection [(12)] (17)(a)(i) that is performed in
146     accordance with a license issued under another chapter of this title;
147          (ii) an ablative cosmetic medical procedure if the scope of practice for the person
148     performing the ablative cosmetic medical procedure includes the authority to operate or
149     perform a surgical procedure; or
150          (iii) conduct under Subsection 58-67-501(2).
151          [(13)] (18) "Prescription device" means an instrument, apparatus, implement, machine,
152     contrivance, implant, in vitro reagent, or other similar or related article, and any component
153     part or accessory, which is required under federal or state law to be prescribed by a practitioner
154     and dispensed by or through a person or entity licensed under this chapter or exempt from
155     licensure under this chapter.
156          [(14)] (19) "Prescription drug" means a drug that is required by federal or state law or
157     rule to be dispensed only by prescription or is restricted to administration only by practitioners.
158          [(15)] (20) "SPEX" means the Special Purpose Examination of the Federation of State
159     Medical Boards.
160          [(16)] (21) "Unlawful conduct" [is as] means the same as that term is defined in
161     Sections 58-1-501 and 58-67-501.
162          [(17)] (22) "Unprofessional conduct" [is as] means the same as that term is defined in
163     Sections 58-1-501 and 58-67-502, and as may be further defined by division rule.
164          Section 2. Section 58-67-302.8 is enacted to read:
165          58-67-302.8. Restricted licensing of an associate physician.
166          (1) An individual may apply for a restricted license as an associate physician if the
167     individual:
168          (a) meets the requirements described in Subsections 58-67-302(1)(a) through (c),

169     (1)(d)(i), and (1)(g) through (j);
170          (b) successfully completes Step 1 and Step 2 of the United States Medical Licensing
171     Examination or the equivalent steps of another board-approved medical licensing examination:
172          (i) within three years after the day on which the applicant graduates from a program
173     described in Subsection 58-67-302(1)(d)(i); and
174          (ii) within two years before applying for a restricted license as an associate physician;
175     and
176          (c) is not currently enrolled in and has not completed a residency program.
177          (2) Before a licensed associate physician may engage in the practice of medicine as
178     described in Subsection (3), the licensed associate physician shall:
179          (a) enter into a collaborative practice arrangement described in Section 58-67-807
180     within six months after the associate physician's initial licensure; and
181          (b) receive division approval of the collaborative practice arrangement.
182          (3) An associate physician's scope of practice is limited to primary care services to
183     medically underserved populations or in medically underserved areas within the state.
184          Section 3. Section 58-67-303 is amended to read:
185          58-67-303. Term of license -- Expiration -- Renewal.
186          (1) (a) Except as provided in Section 58-67-302.7, the division shall issue each license
187     under this chapter in accordance with a two-year renewal cycle established by division rule.
188          (b) The division may by rule extend or shorten a renewal period by as much as one year
189     to stagger the renewal cycles it administers.
190          (2) At the time of renewal, the licensee shall show compliance with:
191          (a) continuing education renewal requirements; and
192          (b) the requirement for designation of a contact person and alternate contact person for
193     access to medical records and notice to patients as required by Subsections 58-67-304(1)(b)
194     and (c).
195          (3) Each license issued under this chapter expires on the expiration date shown on the
196     license unless renewed in accordance with Section 58-1-308.

197          (4) An individual may not be licensed as an associate physician for more than a total of
198     four years.
199          Section 4. Section 58-67-304 is amended to read:
200          58-67-304. License renewal requirements.
201          (1) As a condition precedent for license renewal, each licensee shall, during each
202     two-year licensure cycle or other cycle defined by division rule:
203          (a) complete qualified continuing professional education requirements in accordance
204     with the number of hours and standards defined by division rule made in collaboration with the
205     board;
206          (b) appoint a contact person for access to medical records and an alternate contact
207     person for access to medical records in accordance with Subsection 58-67-302(1)(i); [and]
208          (c) if the licensee practices medicine in a location with no other persons licensed under
209     this chapter, provide some method of notice to the licensee's patients of the identity and
210     location of the contact person and alternate contact person for the licensee[.]; and
211          (d) if the licensee is an associate physician licensed under Section 58-67-302.8,
212     successfully complete the educational methods and programs described in Subsection
213     58-67-807(4).
214          (2) If a renewal period is extended or shortened under Section 58-67-303, the
215     continuing education hours required for license renewal under this section are increased or
216     decreased proportionally.
217          (3) An application to renew a license under this chapter shall:
218          (a) require a physician to answer the following question: "Do you perform elective
219     abortions in Utah in a location other than a hospital?"; and
220          (b) immediately following the question, contain the following statement: "For purposes
221     of the immediately preceding question, elective abortion means an abortion other than one of
222     the following: removal of a dead fetus, removal of an ectopic pregnancy, an abortion that is
223     necessary to avert the death of a woman, an abortion that is necessary to avert a serious risk of
224     substantial and irreversible impairment of a major bodily function of a woman, an abortion of a

225     fetus that has a defect that is uniformly diagnosable and uniformly lethal, or an abortion where
226     the woman is pregnant as a result of rape or incest."
227          (4) In order to assist the Department of Health in fulfilling its responsibilities relating
228     to the licensing of an abortion clinic, if a physician responds positively to the question
229     described in Subsection (3)(a), the division shall, within 30 days after the day on which it
230     renews the physician's license under this chapter, inform the Department of Health in writing:
231          (a) of the name and business address of the physician; and
232          (b) that the physician responded positively to the question described in Subsection
233     (3)(a).
234          Section 5. Section 58-67-502 is amended to read:
235          58-67-502. Unprofessional conduct.
236          (1) "Unprofessional conduct" includes, in addition to the definition in Section
237     58-1-501:
238          (a) using or employing the services of any individual to assist a licensee in any manner
239     not in accordance with the generally recognized practices, standards, or ethics of the
240     profession, state law, or division rule;
241          (b) making a material misrepresentation regarding the qualifications for licensure under
242     Section 58-67-302.7 or Section 58-67-302.8; or
243          (c) violating the dispensing requirements of Chapter 17b, Part 8, Dispensing Medical
244     Practitioner and Dispensing Medical Practitioner Clinic Pharmacy, if applicable.
245          (2) "Unprofessional conduct" does not include, in compliance with Section 58-85-103:
246          (a) obtaining an investigational drug or investigational device;
247          (b) administering the investigational drug to an eligible patient; or
248          (c) treating an eligible patient with the investigational drug or investigational device.
249          Section 6. Section 58-67-601 is amended to read:
250          58-67-601. Mentally incompetent or incapacitated physician.
251          (1) As used in this section:
252          (a) "Incapacitated person" means a person who is incapacitated, as defined in Section

253     75-1-201.
254          (b) "Mental illness" [is as] means the same as that term is defined in Section
255     62A-15-602.
256          (c) "Physician" means an individual licensed under this chapter.
257          (2) If a court of competent jurisdiction determines a physician is an incapacitated
258     person or that the physician has a mental illness and is unable to safely engage in the practice
259     of medicine, the director shall immediately suspend the license of the physician upon the entry
260     of the judgment of the court, without further proceedings under Title 63G, Chapter 4,
261     Administrative Procedures Act, regardless of whether an appeal from the court's ruling is
262     pending. The director shall promptly notify the physician, in writing, of the suspension.
263          (3) (a) If the division and a majority of the board find reasonable cause to believe a
264     physician, who is not determined judicially to be an incapacitated person or to have a mental
265     illness, is incapable of practicing medicine with reasonable skill regarding the safety of
266     patients, because of illness, excessive use of drugs or alcohol, or as a result of any mental or
267     physical condition, the board shall recommend that the director file a petition with the division,
268     and cause the petition to be served upon the physician with a notice of hearing on the sole issue
269     of the capacity of the physician to competently and safely engage in the practice of medicine.
270          (b) The hearing shall be conducted under Section 58-1-109, and Title 63G, Chapter 4,
271     Administrative Procedures Act, except as provided in Subsection (4).
272          (4) (a) Every physician who accepts the privilege of being licensed under this chapter
273     gives consent to:
274          (i) submitting at the physician's own expense to an immediate mental or physical
275     examination when directed in writing by the division and a majority of the board to do so; and
276          (ii) the admissibility of the reports of the examining physician's testimony or
277     examination, and waives all objections on the ground the reports constitute a privileged
278     communication.
279          (b) The examination may be ordered by the division, with the consent of a majority of
280     the board, only upon a finding of reasonable cause to believe:

281          (i) the physician has a mental illness, is incapacitated, or otherwise unable to practice
282     medicine with reasonable skill and safety; and
283          (ii) immediate action by the division and the board is necessary to prevent harm to the
284     physician's patients or the general public.
285          (c) (i) Failure of a physician to submit to the examination ordered under this section is
286     a ground for the division's immediate suspension of the physician's license by written order of
287     the director.
288          (ii) The division may enter the order of suspension without further compliance with
289     Title 63G, Chapter 4, Administrative Procedures Act, unless the division finds the failure to
290     submit to the examination ordered under this section was due to circumstances beyond the
291     control of the physician and was not related directly to the illness or incapacity of the
292     physician.
293          (5) (a) A physician whose license is suspended under Subsection (2) or (3) has the right
294     to a hearing to appeal the suspension within 10 days after the license is suspended.
295          (b) The hearing held under this subsection shall be conducted in accordance with
296     Sections 58-1-108 and 58-1-109 for the sole purpose of determining if sufficient basis exists
297     for the continuance of the order of suspension in order to prevent harm to the physician's
298     patients or the general public.
299          (6) A physician whose license is revoked, suspended, or in any way restricted under
300     this section may request the division and the board to consider, at reasonable intervals,
301     evidence presented by the physician, under procedures established by division rule, regarding
302     any change in the physician's condition, to determine whether:
303          (a) the physician is or is not able to safely and competently engage in the practice of
304     medicine; and
305          (b) the physician is qualified to have the physician's license to practice under this
306     chapter restored completely or in part.
307          Section 7. Section 58-67-807 is enacted to read:
308          58-67-807. Collaborative practice arrangement.

309          (1) (a) The division, in consultation with the board, shall make rules in accordance
310     with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, regarding the approval of a
311     collaborative practice arrangement.
312          (b) The division shall require a collaborative practice arrangement to:
313          (i) limit the associate physician to providing primary care services to medically
314     underserved populations or in medically underserved areas within the state;
315          (ii) be consistent with the skill, training, and competence of the associate physician;
316          (iii) specify jointly agreed-upon protocols, or standing orders for the delivery of health
317     care services by the associate physician;
318          (iv) provide complete names, home and business addresses, zip codes, and telephone
319     numbers of the collaborating physician and the associate physician;
320          (v) list all other offices or locations besides those listed in Subsection (1)(b)(iv) where
321     the collaborating physician authorizes the associate physician to prescribe;
322          (vi) require at every office where the associate physician is authorized to prescribe in
323     collaboration with a physician a prominently displayed disclosure statement informing patients
324     that patients may be seen by an associate physician and have the right to see the collaborating
325     physician;
326          (vii) specify all specialty or board certifications of the collaborating physician and all
327     certifications of the associate physician;
328          (viii) specify the manner of collaboration between the collaborating physician and the
329     associate physician, including how the collaborating physician and the associate physician
330     shall:
331          (A) engage in collaborative practice consistent with each professional's skill, training,
332     education, and competence;
333          (B) maintain geographic proximity, except as provided in Subsection (1)(d); and
334          (C) provide oversight of the associate physician during the absence, incapacity,
335     infirmity, or emergency of the collaborating physician;
336          (ix) describe the associate physician's controlled substance prescriptive authority in

337     collaboration with the collaborating physician, including:
338          (A) a list of the controlled substances the collaborating physician authorizes the
339     associate physician to prescribe; and
340          (B) documentation that the authorization to prescribe the controlled substances is
341     consistent with the education, knowledge, skill, and competence of the associate physician and
342     the collaborating physician;
343          (x) list all other written practice arrangements of the collaborating physician and the
344     associate physician;
345          (xi) specify the duration of the written practice arrangement between the collaborating
346     physician and the associate physician; and
347          (xii) describe the time and manner of the collaborating physician's review of the
348     associate physician's delivery of health care services, including provisions that the
349     collaborating physician, or another physician designated in the collaborative practice
350     arrangement, shall review every 14 days:
351          (A) a minimum of 10% of the charts documenting the associate physician's delivery of
352     health care services; and
353          (B) a minimum of 20% of the charts in which the associate physician prescribes a
354     controlled substance, which may be counted in the number of charts to be reviewed under
355     Subsection (1)(b)(xii)(A).
356          (c) An associate physician and the collaborating physician may modify a collaborative
357     practice arrangement, but the changes to the collaborative practice arrangement are not binding
358     unless:
359          (i) the associate physician notifies the division within 10 days after the day on which
360     the changes are made; and
361          (ii) the division approves the changes.
362          (d) If the collaborative practice arrangement provides for an associate physician to
363     practice in a medically underserved area:
364          (i) the collaborating physician shall document the completion of at least a two-month

365     period of time during which the associate physician shall practice with the collaborating
366     physician continuously present before practicing in a setting where the collaborating physician
367     is not continuously present; and
368          (ii) the collaborating physician shall document the completion of at least 120 hours in a
369     four-month period by the associate physician during which the associate physician shall
370     practice with the collaborating physician on-site before prescribing a controlled substance
371     when the collaborating physician is not on-site.
372          (2) An associate physician:
373          (a) shall clearly identify himself or herself as an associate physician;
374          (b) is permitted to use the title "doctor" or "Dr."; and
375          (c) if authorized under a collaborative practice arrangement to prescribe Schedule III
376     through V controlled substances, shall register with the United States Drug Enforcement
377     Administration as part of the drug enforcement administration's mid-level practitioner registry.
378          (3) (a) A physician or surgeon licensed and in good standing under Section 58-67-302
379     may enter into a collaborative practice arrangement with an associate physician licensed under
380     Section 58-67-302.8.
381          (b) A physician or surgeon may not enter into a collaborative practice arrangement
382     with more than three full-time equivalent associate physicians.
383          (c) (i) No contract or other agreement shall:
384          (A) require a physician to act as a collaborating physician for an associate physician
385     against the physician's will;
386          (B) deny a collaborating physician the right to refuse to act as a collaborating
387     physician, without penalty, for a particular associate physician; or
388          (C) limit the collaborating physician's ultimate authority over any protocols or standing
389     orders or in the delegation of the physician's authority to any associate physician.
390          (ii) Subsection (3)(c)(i)(C) does not authorize a physician, in implementing protocols,
391     standing orders, or delegation, to violate a hospital's established applicable standards for safe
392     medical practice.

393          (d) A collaborating physician is responsible at all times for the oversight of the
394     activities of, and accepts responsibility for, the primary care services rendered by the associate
395     physician.
396          (4) The division shall makes rules, in consultation with the board, the deans of medical
397     schools in the state, and primary care residency program directors in the state, and in
398     accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, establishing
399     educational methods and programs that:
400          (a) an associate physician shall complete throughout the duration of the collaborative
401     practice arrangement;
402          (b) shall facilitate the advancement of the associate physician's medical knowledge and
403     capabilities; and
404          (c) may lead to credit toward a future residency program.
405          Section 8. Section 58-68-102 is amended to read:
406          58-68-102. Definitions.
407          In addition to the definitions in Section 58-1-102, as used in this chapter:
408          (1) "Ablative procedure" means a procedure that is expected to excise, vaporize,
409     disintegrate, or remove living tissue, including the use of carbon dioxide lasers and erbium:
410     YAG lasers, and excluding hair removal.
411          (2) "ACGME" means the Accreditation Council for Graduate Medical Education of the
412     American Medical Association.
413          (3) "Administrative penalty" means a monetary fine imposed by the division for acts or
414     omissions determined to constitute unprofessional or unlawful conduct, as a result of an
415     adjudicative proceeding conducted in accordance with Title 63G, Chapter 4, Administrative
416     Procedures Act.
417          (4) "AOA" means the American Osteopathic Association.
418          (5) "Associate physician" means an individual licensed under Section 58-68-302.5.
419          [(5)] (6) "Board" means the Osteopathic Physician and Surgeon's Licensing Board
420     created in Section 58-68-201.

421          (7) "Collaborating physician" means an individual licensed under Section 58-68-302
422     who enters into a collaborative practice arrangement with an associate physician.
423          (8) "Collaborative practice arrangement" means the arrangement described in Section
424     58-68-807.
425          [(6)] (9) (a) "Cosmetic medical device" means tissue altering energy based devices that
426     have the potential for altering living tissue and that are used to perform ablative or nonablative
427     procedures, such as American National Standards Institute (ANSI) designated Class IIIb and
428     Class IV lasers, intense pulsed light, radio frequency devices, and lipolytic devices and
429     excludes ANSI designated Class IIIa and lower powered devices.
430          (b) Notwithstanding Subsection [(6)] (9)(a), if an ANSI designated Class IIIa and lower
431     powered device is being used to perform an ablative procedure, the device is included in the
432     definition of cosmetic medical device under Subsection [(6)] (9)(a).
433          [(7)] (10) "Cosmetic medical procedure":
434          (a) includes the use of cosmetic medical devices to perform ablative or nonablative
435     procedures; and
436          (b) does not include a treatment of the ocular globe such as refractive surgery.
437          [(8)] (11) "Diagnose" means:
438          (a) to examine in any manner another person, parts of a person's body, substances,
439     fluids, or materials excreted, taken, or removed from a person's body, or produced by a person's
440     body, to determine the source, nature, kind, or extent of a disease or other physical or mental
441     condition;
442          (b) to attempt to conduct an examination or determination described under Subsection
443     [(8)] (11)(a);
444          (c) to hold oneself out as making or to represent that one is making an examination or
445     determination as described in Subsection [(8)] (11)(a); or
446          (d) to make an examination or determination as described in Subsection [(8)] (11)(a)
447     upon or from information supplied directly or indirectly by another person, whether or not in
448     the presence of the person making or attempting the diagnosis or examination.

449          [(9)] (12) "Medical assistant" means an unlicensed individual working under the
450     indirect supervision of a licensed osteopathic physician and surgeon and engaged in specific
451     tasks assigned by the licensed osteopathic physician and surgeon in accordance with the
452     standards and ethics of the profession.
453          (13) "Medically underserved area" means a geographic area in which there is a
454     shortage of primary care health services for residents, as determined by the Department of
455     Health.
456          (14) "Medically underserved population" means a specified group of people living in a
457     defined geographic area with a shortage of primary care health services, as determined by the
458     Department of Health.
459          [(10)] (15) (a) (i) "Nonablative procedure" means a procedure that is expected or
460     intended to alter living tissue, but is not expected or intended to excise, vaporize, disintegrate,
461     or remove living tissue.
462          (ii) Notwithstanding Subsection [(10)] (15)(a)(i), nonablative procedure includes hair
463     removal.
464          (b) "Nonablative procedure" does not include:
465          (i) a superficial procedure as defined in Section 58-1-102;
466          (ii) the application of permanent make-up; or
467          (iii) the use of photo therapy lasers for neuromusculoskeletal treatments that are
468     preformed by an individual licensed under this title who is acting within the individual's scope
469     of practice.
470          [(11)] (16) "Physician" means both physicians and surgeons licensed under Section
471     58-67-301, Utah Medical Practice Act, and osteopathic physicians and surgeons licensed under
472     Section 58-68-301, Utah Osteopathic Medical Practice Act.
473          [(12)] (17) (a) "Practice of osteopathic medicine" means:
474          (i) to diagnose, treat, correct, administer anesthesia, or prescribe for any human
475     disease, ailment, injury, infirmity, deformity, pain, or other condition, physical or mental, real
476     or imaginary, or to attempt to do so, by any means or instrumentality, which in whole or in part

477     is based upon emphasis of the importance of the musculoskeletal system and manipulative
478     therapy in the maintenance and restoration of health, by an individual in Utah or outside of the
479     state upon or for any human within the state;
480          (ii) when a person not licensed as a physician directs a licensee under this chapter to
481     withhold or alter the health care services that the licensee has ordered;
482          (iii) to maintain an office or place of business for the purpose of doing any of the acts
483     described in Subsection [(12)] (17)(a) whether or not for compensation; or
484          (iv) to use, in the conduct of any occupation or profession pertaining to the diagnosis or
485     treatment of human diseases or conditions, in any printed material, stationery, letterhead,
486     envelopes, signs, or advertisements, the designation "doctor," "doctor of osteopathic medicine,"
487     "osteopathic physician," "osteopathic surgeon," "osteopathic physician and surgeon," "Dr.,"
488     "D.O.," or any combination of these designations in any manner which might cause a
489     reasonable person to believe the individual using the designation is a licensed osteopathic
490     physician, and if the party using the designation is not a licensed osteopathic physician, the
491     designation must additionally contain the description of the branch of the healing arts for which
492     the person has a license, provided that an individual who has received an earned degree of
493     doctor of osteopathic medicine but is not a licensed osteopathic physician and surgeon in Utah
494     may use the designation "D.O." if it is followed by "Not Licensed" or "Not Licensed in Utah"
495     in the same size and style of lettering.
496          (b) The practice of osteopathic medicine does not include:
497          (i) except for an ablative medical procedure as provided in Subsection [(12)]
498     (17)(b)(ii), the conduct described in Subsection [(12)] (17)(a)(i) that is performed in
499     accordance with a license issued under another chapter of this title;
500          (ii) an ablative cosmetic medical procedure if the scope of practice for the person
501     performing the ablative cosmetic medical procedure includes the authority to operate or
502     perform a surgical procedure; or
503          (iii) conduct under Subsection 58-68-501(2).
504          [(13)] (18) "Prescription device" means an instrument, apparatus, implement, machine,

505     contrivance, implant, in vitro reagent, or other similar or related article, and any component
506     part or accessory, which is required under federal or state law to be prescribed by a practitioner
507     and dispensed by or through a person or entity licensed under this chapter or exempt from
508     licensure under this chapter.
509          [(14)] (19) "Prescription drug" means a drug that is required by federal or state law or
510     rule to be dispensed only by prescription or is restricted to administration only by practitioners.
511          [(15)] (20) "SPEX" means the Special Purpose Examination of the Federation of State
512     Medical Boards.
513          [(16)] (21) "Unlawful conduct" [is as] means the same as that term is defined in
514     Sections 58-1-501 and 58-68-501.
515          [(17)] (22) "Unprofessional conduct" [is as] means the same as that term is defined in
516     Sections 58-1-501 and 58-68-502 and as may be further defined by division rule.
517          Section 9. Section 58-68-302.5 is enacted to read:
518          58-68-302.5. Restricted licensing of an associate physician.
519          (1) An individual may apply for a restricted license as an associate physician if the
520     individual:
521          (a) meets the requirements described in Subsections 58-68-302(1)(a) through (c),
522     (1)(d)(i), and (1)(g) through (j);
523          (b) successfully completes Step 1 and Step 2 of the United States Medical Licensing
524     Examination or the equivalent steps of another board-approved medical licensing examination:
525          (i) within three years after the day on which the applicant graduates from a program
526     described in Subsection 58-68-302(1)(d)(i); and
527          (ii) within two years before applying for a restricted license as an associate physician;
528     and
529          (c) is not currently enrolled in and has not completed a residency program.
530          (2) Before a licensed associate physician may engage in the practice of medicine as
531     described in Subsection (3), the licensed associate physician shall:
532          (a) enter into a collaborative practice arrangement described in Section 58-68-807

533     within six months after the associate physician's initial licensure; and
534          (b) receive division approval of the collaborative practice arrangement.
535          (3) An associate physician's scope of practice is limited to primary care services to
536     medically underserved populations or in medically underserved areas within the state.
537          Section 10. Section 58-68-303 is amended to read:
538          58-68-303. Term of license -- Expiration -- Renewal.
539          (1) (a) The division shall issue each license under this chapter in accordance with a
540     two-year renewal cycle established by division rule.
541          (b) The division may by rule extend or shorten a renewal period by as much as one year
542     to stagger the renewal cycles it administers.
543          (2) At the time of renewal, the licensee shall show compliance with:
544          (a) continuing education renewal requirements; and
545          (b) the requirement for designation of a contact person and alternate contact person for
546     access to medical records and notice to patients as required by Subsections 58-68-304(1)(b)
547     and (c).
548          (3) Each license issued under this chapter expires on the expiration date shown on the
549     license unless renewed in accordance with Section 58-1-308.
550          (4) An individual may not be licensed as an associate physician for more than a total of
551     four years.
552          Section 11. Section 58-68-304 is amended to read:
553          58-68-304. License renewal requirements.
554          (1) As a condition precedent for license renewal, each licensee shall, during each
555     two-year licensure cycle or other cycle defined by division rule:
556          (a) complete qualified continuing professional education requirements in accordance
557     with the number of hours and standards defined by division rule in collaboration with the
558     board;
559          (b) appoint a contact person for access to medical records and an alternate contact
560     person for access to medical records in accordance with Subsection 58-68-302(1)(i); [and]

561          (c) if the licensee practices osteopathic medicine in a location with no other persons
562     licensed under this chapter, provide some method of notice to the licensee's patients of the
563     identity and location of the contact person and alternate contact person for access to medical
564     records for the licensee in accordance with Subsection 58-68-302(1)(j)[.]; and
565          (d) if the licensee is an associate physician licensed under Section 58-68-302.5,
566     successfully complete the educational methods and programs described in Subsection
567     58-68-807(4).
568          (2) If a renewal period is extended or shortened under Section 58-68-303, the
569     continuing education hours required for license renewal under this section are increased or
570     decreased proportionally.
571          (3) An application to renew a license under this chapter shall:
572          (a) require a physician to answer the following question: "Do you perform elective
573     abortions in Utah in a location other than a hospital?"; and
574          (b) immediately following the question, contain the following statement: "For purposes
575     of the immediately preceding question, elective abortion means an abortion other than one of
576     the following: removal of a dead fetus, removal of an ectopic pregnancy, an abortion that is
577     necessary to avert the death of a woman, an abortion that is necessary to avert a serious risk of
578     substantial and irreversible impairment of a major bodily function of a woman, an abortion of a
579     fetus that has a defect that is uniformly diagnosable and uniformly lethal, or an abortion where
580     the woman is pregnant as a result of rape or incest."
581          (4) In order to assist the Department of Health in fulfilling its responsibilities relating
582     to the licensing of an abortion clinic, if a physician responds positively to the question
583     described in Subsection (3)(a), the division shall, within 30 days after the day on which it
584     renews the physician's license under this chapter, inform the Department of Health in writing:
585          (a) of the name and business address of the physician; and
586          (b) that the physician responded positively to the question described in Subsection
587     (3)(a).
588          Section 12. Section 58-68-502 is amended to read:

589          58-68-502. Unprofessional conduct.
590          (1) "Unprofessional conduct" includes, in addition to the definition in Section
591     58-1-501:
592          (a) using or employing the services of any individual to assist a licensee in any manner
593     not in accordance with the generally recognized practices, standards, or ethics of the
594     profession, state law, or division rule; [or]
595          (b) violating the dispensing requirements of Chapter 17b, Part 8, Dispensing Medical
596     Practitioner and Dispensing Medical Practitioner Clinic Pharmacy, if applicable[.]; or
597          (c) making a material misrepresentation regarding the qualifications for licensure under
598     Section 58-68-302.5.
599          (2) "Unprofessional conduct" does not include, in compliance with Section 58-85-103:
600          (a) obtaining an investigational drug or investigational device;
601          (b) administering the investigational drug to an eligible patient; or
602          (c) treating an eligible patient with the investigational drug or investigational device.
603          Section 13. Section 58-68-601 is amended to read:
604          58-68-601. Mentally incompetent or incapacitated osteopathic physician.
605          (1) As used in this section:
606          (a) "Incapacitated person" means a person who is incapacitated, as defined in Section
607     75-1-201.
608          (b) "Licensee" means an individual licensed under this chapter.
609          [(b)] (c) "Mental illness" [is as] means the same as that term is defined in Section
610     62A-15-602.
611          (2) If a court of competent jurisdiction determines [an osteopathic physician and
612     surgeon] a licensee is an incapacitated person or that the [physician or surgeon] licensee has a
613     mental illness and is unable to safely engage in the practice of medicine, the director shall
614     immediately suspend the license of the [osteopathic physician and surgeon] licensee upon the
615     entry of the judgment of the court, without further proceedings under Title 63G, Chapter 4,
616     Administrative Procedures Act, regardless of whether an appeal from the court's ruling is

617     pending. The director shall promptly notify the [osteopathic physician and surgeon] licensee,
618     in writing, of the suspension.
619          (3) (a) If the division and a majority of the board find reasonable cause to believe [an
620     osteopathic physician and surgeon] a licensee, who is not determined judicially to be an
621     incapacitated person or to have a mental illness, is incapable of practicing osteopathic medicine
622     with reasonable skill regarding the safety of patients, because of illness, excessive use of drugs
623     or alcohol, or as a result of any mental or physical condition, the board shall recommend that
624     the director file a petition with the division, and cause the petition to be served upon the
625     [osteopathic physician and surgeon] licensee with a notice of hearing on the sole issue of the
626     capacity of the [osteopathic physician and surgeon] licensee to competently and [safety] safely
627     engage in the practice of medicine.
628          (b) The hearing shall be conducted under Section 58-1-109, and Title 63G, Chapter 4,
629     Administrative Procedures Act, except as provided in Subsection (4).
630          (4) (a) Every [osteopathic physician and surgeon] individual who accepts the privilege
631     of being licensed under this chapter gives consent to:
632          (i) submitting at the [physician's or surgeon's] licensee's own expense to an immediate
633     mental or physical examination when directed in writing by the division and a majority of the
634     board to do so; and
635          (ii) the admissibility of the reports of the examining physician's testimony or
636     examination, and waives all objections on the ground the reports constitute a privileged
637     communication.
638          (b) The examination may be ordered by the division, with the consent of a majority of
639     the board, only upon a finding of reasonable cause to believe:
640          (i) the [osteopathic physician and surgeon] licensee has a mental illness, is
641     incapacitated, or otherwise unable to practice medicine with reasonable skill and safety; and
642          (ii) immediate action by the division and the board is necessary to prevent harm to the
643     [osteopathic physician and surgeon's] licensee's patients or the general public.
644          (c) (i) Failure of [an osteopathic physician and surgeon] a licensee to submit to the

645     examination ordered under this section is a ground for the division's immediate suspension of
646     the [osteopathic physician and surgeon's] licensee's license by written order of the director.
647          (ii) The division may enter the order of suspension without further compliance with
648     Title 63G, Chapter 4, Administrative Procedures Act, unless the division finds the failure to
649     submit to the examination ordered under this section was due to circumstances beyond the
650     control of the [osteopathic physician and surgeon] licensee and was not related directly to the
651     illness or incapacity of the [osteopathic physician and surgeon] licensee.
652          (5) (a) [An osteopathic physician and surgeon] A licensee whose license is suspended
653     under Subsection (2) or (3) has the right to a hearing to appeal the suspension within 10 days
654     after the license is suspended.
655          (b) The hearing held under this subsection shall be conducted in accordance with
656     Sections 58-1-108 and 58-1-109 for the sole purpose of determining if sufficient basis exists
657     for the continuance of the order of suspension in order to prevent harm to the [osteopathic
658     physician and surgeon's] licensee's patients or the general public.
659          (6) [An osteopathic physician and surgeon] A licensee whose license is revoked,
660     suspended, or in any way restricted under this section may request the division and the board to
661     consider, at reasonable intervals, evidence presented by the [osteopathic physician and surgeon]
662     licensee, under procedures established by division rule, regarding any change in the
663     [osteopathic physician and surgeon's] licensee's condition, to determine whether:
664          (a) the [physician or surgeon] licensee is or is not able to safely and competently
665     engage in the practice of medicine; and
666          (b) the [physician or surgeon] licensee is qualified to have the [physician's or
667     surgeon's] licensee's license to practice under this chapter restored completely or in part.
668          Section 14. Section 58-68-807 is enacted to read:
669          58-68-807. Collaborative practice arrangement.
670          (1) (a) The division, in consultation with the board, shall make rules in accordance
671     with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, regarding the approval of a
672     collaborative practice arrangement.

673          (b) The division shall require a collaborative practice arrangement to:
674          (i) limit the associate physician to providing primary care services to medically
675     underserved populations or in medically underserved areas within the state;
676          (ii) be consistent with the skill, training, and competence of the associate physician;
677          (iii) specify jointly agreed-upon protocols, or standing orders for the delivery of health
678     care services by the associate physician;
679          (iv) provide complete names, home and business addresses, zip codes, and telephone
680     numbers of the collaborating physician and the associate physician;
681          (v) list all other offices or locations besides those listed in Subsection (1)(b)(iv) where
682     the collaborating physician authorizes the associate physician to prescribe;
683          (vi) require at every office where the associate physician is authorized to prescribe in
684     collaboration with a physician a prominently displayed disclosure statement informing patients
685     that patients may be seen by an associate physician and have the right to see the collaborating
686     physician;
687          (vii) specify all specialty or board certifications of the collaborating physician and all
688     certifications of the associate physician;
689          (viii) specify the manner of collaboration between the collaborating physician and the
690     associate physician, including how the collaborating physician and the associate physician
691     shall:
692          (A) engage in collaborative practice consistent with each professional's skill, training,
693     education, and competence;
694          (B) maintain geographic proximity, except as provided in Subsection (1)(d); and
695          (C) provide oversight of the associate physician during the absence, incapacity,
696     infirmity, or emergency of the collaborating physician;
697          (ix) describe the associate physician's controlled substance prescriptive authority in
698     collaboration with the collaborating physician, including:
699          (A) a list of the controlled substances the collaborating physician authorizes the
700     associate physician to prescribe; and

701          (B) documentation that the authorization to prescribe the controlled substances is
702     consistent with the education, knowledge, skill, and competence of the associate physician and
703     the collaborating physician;
704          (x) list all other written practice arrangements of the collaborating physician and the
705     associate physician;
706          (xi) specify the duration of the written practice arrangement between the collaborating
707     physician and the associate physician; and
708          (xii) describe the time and manner of the collaborating physician's review of the
709     associate physician's delivery of health care services, including provisions that the
710     collaborating physician, or another physician designated in the collaborative practice
711     arrangement, shall review every 14 days:
712          (A) a minimum of 10% of the charts documenting the associate physician's delivery of
713     health care services; and
714          (B) a minimum of 20% of the charts in which the associate physician prescribes a
715     controlled substance, which may be counted in the number of charts to be reviewed under
716     Subsection (1)(b)(xii)(A).
717          (c) An associate physician and the collaborating physician may modify a collaborative
718     practice arrangement, but the changes to the collaborative practice arrangement are not binding
719     unless:
720          (i) the associate physician notifies the division within 10 days after the day on which
721     the changes are made; and
722          (ii) the division approves the changes.
723          (d) If the collaborative practice arrangement provides for an associate physician to
724     practice in a medically underserved area:
725          (i) the collaborating physician shall document the completion of at least a two-month
726     period of time during which the associate physician shall practice with the collaborating
727     physician continuously present before practicing in a setting where the collaborating physician
728     is not continuously present; and

729          (ii) the collaborating physician shall document the completion of at least 120 hours in a
730     four-month period by the associate physician during which the associate physician shall
731     practice with the collaborating physician on-site before prescribing a controlled substance
732     when the collaborating physician is not on-site.
733          (2) An associate physician:
734          (a) shall clearly identify himself or herself as an associate physician;
735          (b) is permitted to use the title "doctor" or "Dr."; and
736          (c) if authorized under a collaborative practice arrangement to prescribe Schedule III
737     through V controlled substances, shall register with the United States Drug Enforcement
738     Administration as part of the drug enforcement administration's mid-level practitioner registry.
739          (3) (a) A physician or surgeon licensed and in good standing under Section 58-68-302
740     may enter into a collaborative practice arrangement with an associate physician licensed under
741     Section 58-68-302.5.
742          (b) A physician or surgeon may not enter into a collaborative practice arrangement
743     with more than three full-time equivalent associate physicians.
744          (c) (i) No contract or other agreement shall:
745          (A) require a physician to act as a collaborating physician for an associate physician
746     against the physician's will;
747          (B) deny a collaborating physician the right to refuse to act as a collaborating
748     physician, without penalty, for a particular associate physician; or
749          (C) limit the collaborating physician's ultimate authority over any protocols or standing
750     orders or in the delegation of the physician's authority to any associate physician.
751          (ii) Subsection (3)(c)(i)(C) does not authorize a physician, in implementing such
752     protocols, standing orders, or delegation, to violate a hospital's established applicable standards
753     for safe medical practice.
754          (d) A collaborating physician is responsible at all times for the oversight of the
755     activities of, and accepts responsibility for, the primary care services rendered by the associate
756     physician.

757          (4) The division shall makes rules, in consultation with the board, the deans of medical
758     schools in the state, and primary care residency program directors in the state, and in
759     accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, establishing
760     educational methods and programs that:
761          (a) an associate physician shall complete throughout the duration of the collaborative
762     practice arrangement;
763          (b) shall facilitate the advancement of the associate physician's medical knowledge and
764     capabilities; and
765          (c) may lead to credit toward a future residency program.
766          Section 15. Effective date.
767          This bill takes effect on July 1, 2018.