This document includes Senate Committee Amendments incorporated into the bill on Thu, Mar 5, 2020 at 10:48 AM by lpoole.
1     
ASSOCIATE PHYSICIAN LICENSE AMENDMENTS

2     
2020 GENERAL SESSION

3     
STATE OF UTAH

4     
Chief Sponsor: Stewart E. Barlow

5     
Senate Sponsor: David G. Buxton

6     

7     LONG TITLE
8     General Description:
9          This bill amends the licensing requirements for associate physicians.
10     Highlighted Provisions:
11          This bill:
12          ▸     changes the areas where associate physicians can practice; and
13          ▸     changes the time period for which associate physicians can be licensed.
14     Money Appropriated in this Bill:
15          None
16     Other Special Clauses:
17          None
18     Utah Code Sections Affected:
19     AMENDS:
20          58-67-302.8, as last amended by Laws of Utah 2018, Chapter 318
21          58-67-303, as last amended by Laws of Utah 2019, Chapter 447
22          58-67-807, as enacted by Laws of Utah 2017, Chapter 299
23          58-68-302.5, as last amended by Laws of Utah 2018, Chapter 318
24          58-68-303, as last amended by Laws of Utah 2019, Chapter 447
25          58-68-807, as enacted by Laws of Utah 2017, Chapter 299
26     

27     Be it enacted by the Legislature of the state of Utah:

28          Section 1. Section 58-67-302.8 is amended to read:
29          58-67-302.8. Restricted licensing of an associate physician.
30          (1) An individual may apply for a restricted license as an associate physician if the
31     individual:
32          (a) meets the requirements described in Subsections 58-67-302(1)(a) through (d),
33     (1)(e)(i), and (1)(h) through (k);
34          (b) successfully completes Step 1 and Step 2 of the United States Medical Licensing
35     Examination or the equivalent steps of another board-approved medical licensing examination:
36          (i) within three years after the day on which the applicant graduates from a program
37     described in Subsection 58-67-302(1)(e)(i); and
38          (ii) within two years before applying for a restricted license as an associate physician;
39     and
40          (c) is not currently enrolled in and has not completed a residency program.
41          (2) Before a licensed associate physician may engage in the practice of medicine as
42     described in Subsection (3), the licensed associate physician shall:
43          (a) enter into a collaborative practice arrangement described in Section 58-67-807
44     within six months after the associate physician's initial licensure; and
45          (b) receive division approval of the collaborative practice arrangement.
46          (3) An associate physician's scope of practice is limited to primary care services [to
47     medically underserved populations or in medically underserved areas within the state].
48          Section 2. Section 58-67-303 is amended to read:
49          58-67-303. Term of license -- Expiration -- Renewal.
50          (1) (a) Except as provided in Section 58-67-302.7, the division shall issue each license
51     under this chapter in accordance with a two-year renewal cycle established by division rule.
52          (b) The division may by rule extend or shorten a renewal period by as much as one year
53     to stagger the renewal cycles the division administers.
54          (2) At the time of renewal, the licensee shall:
55          (a) view a suicide prevention video described in Section 58-1-601 and submit proof in
56     the form required by the division;
57          (b) show compliance with continuing education renewal requirements; and
58          (c) show compliance with the requirement for designation of a contact person and

59     alternate contact person for access to medical records and notice to patients as required by
60     Subsections 58-67-304(1)(b) and (c).
61          (3) Each license issued under this chapter expires on the expiration date shown on the
62     license unless renewed in accordance with Section 58-1-308.
63          Ŝ→ [
[] ←Ŝ (4) An individual may not be licensed as an associate physician for more than a
63a     total
64     of Ŝ→ [
four] six ←Ŝ years. Ŝ→ []] ←Ŝ
65          Section 3. Section 58-67-807 is amended to read:
66          58-67-807. Collaborative practice arrangement.
67          (1) (a) The division, in consultation with the board, shall make rules in accordance
68     with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, regarding the approval of a
69     collaborative practice arrangement.
70          (b) The division shall require a collaborative practice arrangement to:
71          (i) limit the associate physician to providing primary care services [to medically
72     underserved populations or in medically underserved areas within the state];
73          (ii) be consistent with the skill, training, and competence of the associate physician;
74          (iii) specify jointly agreed-upon protocols, or standing orders for the delivery of health
75     care services by the associate physician;
76          (iv) provide complete names, home and business addresses, zip codes, and telephone
77     numbers of the collaborating physician and the associate physician;
78          (v) list all other offices or locations besides those listed in Subsection (1)(b)(iv) where
79     the collaborating physician authorizes the associate physician to prescribe;
80          (vi) require at every office where the associate physician is authorized to prescribe in
81     collaboration with a physician a prominently displayed disclosure statement informing patients
82     that patients may be seen by an associate physician and have the right to see the collaborating
83     physician;
84          (vii) specify all specialty or board certifications of the collaborating physician and all
85     certifications of the associate physician;
86          (viii) specify the manner of collaboration between the collaborating physician and the
87     associate physician, including how the collaborating physician and the associate physician
88     shall:
89          (A) engage in collaborative practice consistent with each professional's skill, training,

90     education, and competence;
91          (B) maintain geographic proximity, except as provided in Subsection (1)(d); and
92          (C) provide oversight of the associate physician during the absence, incapacity,
93     infirmity, or emergency of the collaborating physician;
94          (ix) describe the associate physician's controlled substance prescriptive authority in
95     collaboration with the collaborating physician, including:
96          (A) a list of the controlled substances the collaborating physician authorizes the
97     associate physician to prescribe; and
98          (B) documentation that the authorization to prescribe the controlled substances is
99     consistent with the education, knowledge, skill, and competence of the associate physician and
100     the collaborating physician;
101          (x) list all other written practice arrangements of the collaborating physician and the
102     associate physician;
103          (xi) specify the duration of the written practice arrangement between the collaborating
104     physician and the associate physician; and
105          (xii) describe the time and manner of the collaborating physician's review of the
106     associate physician's delivery of health care services, including provisions that the
107     collaborating physician, or another physician designated in the collaborative practice
108     arrangement, shall review every 14 days:
109          (A) a minimum of 10% of the charts documenting the associate physician's delivery of
110     health care services; and
111          (B) a minimum of 20% of the charts in which the associate physician prescribes a
112     controlled substance, which may be counted in the number of charts to be reviewed under
113     Subsection (1)(b)(xii)(A).
114          (c) An associate physician and the collaborating physician may modify a collaborative
115     practice arrangement, but the changes to the collaborative practice arrangement are not binding
116     unless:
117          (i) the associate physician notifies the division within 10 days after the day on which
118     the changes are made; and
119          (ii) the division approves the changes.
120          (d) If the collaborative practice arrangement provides for an associate physician to

121     practice in a medically underserved area:
122          (i) the collaborating physician shall document the completion of at least a two-month
123     period of time during which the associate physician shall practice with the collaborating
124     physician continuously present before practicing in a setting where the collaborating physician
125     is not continuously present; and
126          (ii) the collaborating physician shall document the completion of at least 120 hours in a
127     four-month period by the associate physician during which the associate physician shall
128     practice with the collaborating physician on-site before prescribing a controlled substance
129     when the collaborating physician is not on-site.
130          (2) An associate physician:
131          (a) shall clearly identify himself or herself as an associate physician;
132          (b) is permitted to use the title "doctor" or "Dr."; and
133          (c) if authorized under a collaborative practice arrangement to prescribe Schedule III
134     through V controlled substances, shall register with the United States Drug Enforcement
135     Administration as part of the drug enforcement administration's mid-level practitioner registry.
136          (3) (a) A physician or surgeon licensed and in good standing under Section 58-67-302
137     may enter into a collaborative practice arrangement with an associate physician licensed under
138     Section 58-67-302.8.
139          (b) A physician or surgeon may not enter into a collaborative practice arrangement
140     with more than three full-time equivalent associate physicians.
141          (c) (i) No contract or other agreement shall:
142          (A) require a physician to act as a collaborating physician for an associate physician
143     against the physician's will;
144          (B) deny a collaborating physician the right to refuse to act as a collaborating
145     physician, without penalty, for a particular associate physician; or
146          (C) limit the collaborating physician's ultimate authority over any protocols or standing
147     orders or in the delegation of the physician's authority to any associate physician.
148          (ii) Subsection (3)(c)(i)(C) does not authorize a physician, in implementing protocols,
149     standing orders, or delegation, to violate a hospital's established applicable standards for safe
150     medical practice.
151          (d) A collaborating physician is responsible at all times for the oversight of the

152     activities of, and accepts responsibility for, the primary care services rendered by the associate
153     physician.
154          (4) The division shall makes rules, in consultation with the board, the deans of medical
155     schools in the state, and primary care residency program directors in the state, and in
156     accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, establishing
157     educational methods and programs that:
158          (a) an associate physician shall complete throughout the duration of the collaborative
159     practice arrangement;
160          (b) shall facilitate the advancement of the associate physician's medical knowledge and
161     capabilities; and
162          (c) may lead to credit toward a future residency program.
163          Section 4. Section 58-68-302.5 is amended to read:
164          58-68-302.5. Restricted licensing of an associate physician.
165          (1) An individual may apply for a restricted license as an associate physician if the
166     individual:
167          (a) meets the requirements described in Subsections 58-68-302(1)(a) through (d),
168     (1)(e)(i), and (1)(h) through (k);
169          (b) successfully completes Step 1 and Step 2 of the United States Medical Licensing
170     Examination or the equivalent steps of another board-approved medical licensing examination:
171          (i) within three years after the day on which the applicant graduates from a program
172     described in Subsection 58-68-302(1)(e)(i); and
173          (ii) within two years before applying for a restricted license as an associate physician;
174     and
175          (c) is not currently enrolled in and has not completed a residency program.
176          (2) Before a licensed associate physician may engage in the practice of medicine as
177     described in Subsection (3), the licensed associate physician shall:
178          (a) enter into a collaborative practice arrangement described in Section 58-68-807
179     within six months after the associate physician's initial licensure; and
180          (b) receive division approval of the collaborative practice arrangement.
181          (3) An associate physician's scope of practice is limited to primary care services [to
182     medically underserved populations or in medically underserved areas within the state].

183          Section 5. Section 58-68-303 is amended to read:
184          58-68-303. Term of license -- Expiration -- Renewal.
185          (1) (a) The division shall issue each license under this chapter in accordance with a
186     two-year renewal cycle established by division rule.
187          (b) The division may by rule extend or shorten a renewal period by as much as one year
188     to stagger the renewal cycles the division administers.
189          (2) At the time of renewal, the licensee shall:
190          (a) view a suicide prevention video described in Section 58-1-601 and submit proof in
191     the form required by the division;
192          (b) show compliance with continuing education renewal requirements; and
193          (c) show compliance with the requirement for designation of a contact person and
194     alternate contact person for access to medical records and notice to patients as required by
195     Subsections 58-68-304(1)(b) and (c).
196          (3) Each license issued under this chapter expires on the expiration date shown on the
197     license unless renewed in accordance with Section 58-1-308.
198          Ŝ→ [
[] ←Ŝ (4) An individual may not be licensed as an associate physician for more than a
198a     total
199     of Ŝ→ [
four] six ←Ŝ years. Ŝ→ []] ←Ŝ
200          Section 6. Section 58-68-807 is amended to read:
201          58-68-807. Collaborative practice arrangement.
202          (1) (a) The division, in consultation with the board, shall make rules in accordance
203     with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, regarding the approval of a
204     collaborative practice arrangement.
205          (b) The division shall require a collaborative practice arrangement to:
206          (i) limit the associate physician to providing primary care services [to medically
207     underserved populations or in medically underserved areas within the state];
208          (ii) be consistent with the skill, training, and competence of the associate physician;
209          (iii) specify jointly agreed-upon protocols, or standing orders for the delivery of health
210     care services by the associate physician;
211          (iv) provide complete names, home and business addresses, zip codes, and telephone
212     numbers of the collaborating physician and the associate physician;
213          (v) list all other offices or locations besides those listed in Subsection (1)(b)(iv) where

214     the collaborating physician authorizes the associate physician to prescribe;
215          (vi) require at every office where the associate physician is authorized to prescribe in
216     collaboration with a physician a prominently displayed disclosure statement informing patients
217     that patients may be seen by an associate physician and have the right to see the collaborating
218     physician;
219          (vii) specify all specialty or board certifications of the collaborating physician and all
220     certifications of the associate physician;
221          (viii) specify the manner of collaboration between the collaborating physician and the
222     associate physician, including how the collaborating physician and the associate physician
223     shall:
224          (A) engage in collaborative practice consistent with each professional's skill, training,
225     education, and competence;
226          (B) maintain geographic proximity, except as provided in Subsection (1)(d); and
227          (C) provide oversight of the associate physician during the absence, incapacity,
228     infirmity, or emergency of the collaborating physician;
229          (ix) describe the associate physician's controlled substance prescriptive authority in
230     collaboration with the collaborating physician, including:
231          (A) a list of the controlled substances the collaborating physician authorizes the
232     associate physician to prescribe; and
233          (B) documentation that the authorization to prescribe the controlled substances is
234     consistent with the education, knowledge, skill, and competence of the associate physician and
235     the collaborating physician;
236          (x) list all other written practice arrangements of the collaborating physician and the
237     associate physician;
238          (xi) specify the duration of the written practice arrangement between the collaborating
239     physician and the associate physician; and
240          (xii) describe the time and manner of the collaborating physician's review of the
241     associate physician's delivery of health care services, including provisions that the
242     collaborating physician, or another physician designated in the collaborative practice
243     arrangement, shall review every 14 days:
244          (A) a minimum of 10% of the charts documenting the associate physician's delivery of

245     health care services; and
246          (B) a minimum of 20% of the charts in which the associate physician prescribes a
247     controlled substance, which may be counted in the number of charts to be reviewed under
248     Subsection (1)(b)(xii)(A).
249          (c) An associate physician and the collaborating physician may modify a collaborative
250     practice arrangement, but the changes to the collaborative practice arrangement are not binding
251     unless:
252          (i) the associate physician notifies the division within 10 days after the day on which
253     the changes are made; and
254          (ii) the division approves the changes.
255          (d) If the collaborative practice arrangement provides for an associate physician to
256     practice in a medically underserved area:
257          (i) the collaborating physician shall document the completion of at least a two-month
258     period of time during which the associate physician shall practice with the collaborating
259     physician continuously present before practicing in a setting where the collaborating physician
260     is not continuously present; and
261          (ii) the collaborating physician shall document the completion of at least 120 hours in a
262     four-month period by the associate physician during which the associate physician shall
263     practice with the collaborating physician on-site before prescribing a controlled substance
264     when the collaborating physician is not on-site.
265          (2) An associate physician:
266          (a) shall clearly identify himself or herself as an associate physician;
267          (b) is permitted to use the title "doctor" or "Dr."; and
268          (c) if authorized under a collaborative practice arrangement to prescribe Schedule III
269     through V controlled substances, shall register with the United States Drug Enforcement
270     Administration as part of the drug enforcement administration's mid-level practitioner registry.
271          (3) (a) A physician or surgeon licensed and in good standing under Section 58-68-302
272     may enter into a collaborative practice arrangement with an associate physician licensed under
273     Section 58-68-302.5.
274          (b) A physician or surgeon may not enter into a collaborative practice arrangement
275     with more than three full-time equivalent associate physicians.

276          (c) (i) No contract or other agreement shall:
277          (A) require a physician to act as a collaborating physician for an associate physician
278     against the physician's will;
279          (B) deny a collaborating physician the right to refuse to act as a collaborating
280     physician, without penalty, for a particular associate physician; or
281          (C) limit the collaborating physician's ultimate authority over any protocols or standing
282     orders or in the delegation of the physician's authority to any associate physician.
283          (ii) Subsection (3)(c)(i)(C) does not authorize a physician, in implementing such
284     protocols, standing orders, or delegation, to violate a hospital's established applicable standards
285     for safe medical practice.
286          (d) A collaborating physician is responsible at all times for the oversight of the
287     activities of, and accepts responsibility for, the primary care services rendered by the associate
288     physician.
289          (4) The division shall makes rules, in consultation with the board, the deans of medical
290     schools in the state, and primary care residency program directors in the state, and in
291     accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, establishing
292     educational methods and programs that:
293          (a) an associate physician shall complete throughout the duration of the collaborative
294     practice arrangement;
295          (b) shall facilitate the advancement of the associate physician's medical knowledge and
296     capabilities; and
297          (c) may lead to credit toward a future residency program.