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8 LONG TITLE
9 General Description:
10 This bill amends the licensing requirements for associate physicians and physician
11 assistants.
12 Highlighted Provisions:
13 This bill:
14 ▸ authorizes a physician assistant to work as a mental health therapist;
15 ▸ changes the areas where associate physicians can practice; and
16 ▸ changes the time period for which associate physicians can be licensed.
17 Money Appropriated in this Bill:
18 None
19 Other Special Clauses:
20 None
21 Utah Code Sections Affected:
22 AMENDS:
23 58-60-102, as last amended by Laws of Utah 2013, Chapters 16 and 123
24 58-67-302.8, as last amended by Laws of Utah 2018, Chapter 318
25 58-67-303, as last amended by Laws of Utah 2019, Chapter 447
26 58-67-807, as enacted by Laws of Utah 2017, Chapter 299
27 58-68-302.5, as last amended by Laws of Utah 2018, Chapter 318
28 58-68-303, as last amended by Laws of Utah 2019, Chapter 447
29 58-68-807, as enacted by Laws of Utah 2017, Chapter 299
30
31 Be it enacted by the Legislature of the state of Utah:
32 Section 1. Section 58-60-102 is amended to read:
33 58-60-102. Definitions.
34 In addition to the definitions in Section 58-1-102, as used in this chapter:
35 (1) "Client" or "patient" means an individual who consults or is examined or
36 interviewed by an individual licensed under this chapter who is acting in the individual's
37 professional capacity.
38 (2) "Confidential communication" means information obtained by an individual
39 licensed under this chapter, including information obtained by the individual's examination of
40 the client or patient, which is:
41 (a) (i) transmitted between the client or patient and an individual licensed under this
42 chapter in the course of that relationship; or
43 (ii) transmitted among the client or patient, an individual licensed under this chapter,
44 and individuals who are participating in the diagnosis or treatment under the direction of an
45 individual licensed under this chapter, including members of the client's or patient's family; and
46 (b) made in confidence, for the diagnosis or treatment of the client or patient by the
47 individual licensed under this chapter, and by a means not intended to be disclosed to third
48 persons other than those individuals:
49 (i) present to further the interest of the client or patient in the consultation,
50 examination, or interview;
51 (ii) reasonably necessary for the transmission of the communications; or
52 (iii) participating in the diagnosis and treatment of the client or patient under the
53 direction of the mental health therapist.
54 (3) "Hypnosis" means, when referring to individuals exempted from licensure under
55 this chapter, a process by which an individual induces or assists another individual into a
56 hypnotic state without the use of drugs or other substances and for the purpose of increasing
57 motivation or to assist the individual to alter lifestyles or habits.
58 (4) "Individual" means a natural person.
59 (5) "Mental health therapist" means an individual who is practicing within the scope of
60 practice defined in the individual's respective licensing act and is licensed under this title as:
61 (a) a physician and surgeon, or osteopathic physician engaged in the practice of mental
62 health therapy;
63 (b) an advanced practice registered nurse, specializing in psychiatric mental health
64 nursing;
65 (c) an advanced practice registered nurse intern, specializing in psychiatric mental
66 health nursing;
67 (d) a psychologist qualified to engage in the practice of mental health therapy;
68 (e) a certified psychology resident qualifying to engage in the practice of mental health
69 therapy;
70 (f) a clinical social worker;
71 (g) a certified social worker;
72 (h) a marriage and family therapist;
73 (i) an associate marriage and family therapist;
74 (j) a clinical mental health counselor; [
75 (k) an associate clinical mental health counselor[
76 (l) a physician assistant practicing under the supervision of a psychiatrist.
77 (6) "Mental illness" means a mental or emotional condition defined in an approved
78 diagnostic and statistical manual for mental disorders generally recognized in the professions of
79 mental health therapy listed under Subsection (5).
80 (7) "Practice of mental health therapy" means treatment or prevention of mental illness,
81 whether in person or remotely, including:
82 (a) conducting a professional evaluation of an individual's condition of mental health,
83 mental illness, or emotional disorder consistent with standards generally recognized in the
84 professions of mental health therapy listed under Subsection (5);
85 (b) establishing a diagnosis in accordance with established written standards generally
86 recognized in the professions of mental health therapy listed under Subsection (5);
87 (c) prescribing a plan for the prevention or treatment of a condition of mental illness or
88 emotional disorder; and
89 (d) engaging in the conduct of professional intervention, including psychotherapy by
90 the application of established methods and procedures generally recognized in the professions
91 of mental health therapy listed under Subsection (5).
92 (8) "Remotely" means communicating via Internet, telephone, or other electronic
93 means that facilitate real-time audio or visual interaction between individuals when they are not
94 physically present in the same room at the same time.
95 (9) "Unlawful conduct" is as defined in Sections 58-1-501 and 58-60-109.
96 (10) "Unprofessional conduct" is as defined in Sections 58-1-501 and 58-60-110, and
97 may be further defined by division rule.
98 Section 2. Section 58-67-302.8 is amended to read:
99 58-67-302.8. Restricted licensing of an associate physician.
100 (1) An individual may apply for a restricted license as an associate physician if the
101 individual:
102 (a) meets the requirements described in Subsections 58-67-302(1)(a) through (d),
103 (1)(e)(i), and (1)(h) through (k);
104 (b) successfully completes Step 1 and Step 2 of the United States Medical Licensing
105 Examination or the equivalent steps of another board-approved medical licensing examination:
106 (i) within three years after the day on which the applicant graduates from a program
107 described in Subsection 58-67-302(1)(e)(i); and
108 (ii) within two years before applying for a restricted license as an associate physician;
109 and
110 (c) is not currently enrolled in and has not completed a residency program.
111 (2) Before a licensed associate physician may engage in the practice of medicine as
112 described in Subsection (3), the licensed associate physician shall:
113 (a) enter into a collaborative practice arrangement described in Section 58-67-807
114 within six months after the associate physician's initial licensure; and
115 (b) receive division approval of the collaborative practice arrangement.
116 (3) An associate physician's scope of practice is limited to primary care services [
117
118 Section 3. Section 58-67-303 is amended to read:
119 58-67-303. Term of license -- Expiration -- Renewal.
120 (1) (a) Except as provided in Section 58-67-302.7, the division shall issue each license
121 under this chapter in accordance with a two-year renewal cycle established by division rule.
122 (b) The division may by rule extend or shorten a renewal period by as much as one year
123 to stagger the renewal cycles the division administers.
124 (2) At the time of renewal, the licensee shall:
125 (a) view a suicide prevention video described in Section 58-1-601 and submit proof in
126 the form required by the division;
127 (b) show compliance with continuing education renewal requirements; and
128 (c) show compliance with the requirement for designation of a contact person and
129 alternate contact person for access to medical records and notice to patients as required by
130 Subsections 58-67-304(1)(b) and (c).
131 (3) Each license issued under this chapter expires on the expiration date shown on the
132 license unless renewed in accordance with Section 58-1-308.
133 (4) An individual may not be licensed as an associate physician for more than a total of
134 [
135 Section 4. Section 58-67-807 is amended to read:
136 58-67-807. Collaborative practice arrangement.
137 (1) (a) The division, in consultation with the board, shall make rules in accordance
138 with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, regarding the approval of a
139 collaborative practice arrangement.
140 (b) The division shall require a collaborative practice arrangement to:
141 (i) limit the associate physician to providing primary care services [
142
143 (ii) be consistent with the skill, training, and competence of the associate physician;
144 (iii) specify jointly agreed-upon protocols, or standing orders for the delivery of health
145 care services by the associate physician;
146 (iv) provide complete names, home and business addresses, zip codes, and telephone
147 numbers of the collaborating physician and the associate physician;
148 (v) list all other offices or locations besides those listed in Subsection (1)(b)(iv) where
149 the collaborating physician authorizes the associate physician to prescribe;
150 (vi) require at every office where the associate physician is authorized to prescribe in
151 collaboration with a physician a prominently displayed disclosure statement informing patients
152 that patients may be seen by an associate physician and have the right to see the collaborating
153 physician;
154 (vii) specify all specialty or board certifications of the collaborating physician and all
155 certifications of the associate physician;
156 (viii) specify the manner of collaboration between the collaborating physician and the
157 associate physician, including how the collaborating physician and the associate physician
158 shall:
159 (A) engage in collaborative practice consistent with each professional's skill, training,
160 education, and competence;
161 (B) maintain geographic proximity, except as provided in Subsection (1)(d); and
162 (C) provide oversight of the associate physician during the absence, incapacity,
163 infirmity, or emergency of the collaborating physician;
164 (ix) describe the associate physician's controlled substance prescriptive authority in
165 collaboration with the collaborating physician, including:
166 (A) a list of the controlled substances the collaborating physician authorizes the
167 associate physician to prescribe; and
168 (B) documentation that the authorization to prescribe the controlled substances is
169 consistent with the education, knowledge, skill, and competence of the associate physician and
170 the collaborating physician;
171 (x) list all other written practice arrangements of the collaborating physician and the
172 associate physician;
173 (xi) specify the duration of the written practice arrangement between the collaborating
174 physician and the associate physician; and
175 (xii) describe the time and manner of the collaborating physician's review of the
176 associate physician's delivery of health care services, including provisions that the
177 collaborating physician, or another physician designated in the collaborative practice
178 arrangement, shall review every 14 days:
179 (A) a minimum of 10% of the charts documenting the associate physician's delivery of
180 health care services; and
181 (B) a minimum of 20% of the charts in which the associate physician prescribes a
182 controlled substance, which may be counted in the number of charts to be reviewed under
183 Subsection (1)(b)(xii)(A).
184 (c) An associate physician and the collaborating physician may modify a collaborative
185 practice arrangement, but the changes to the collaborative practice arrangement are not binding
186 unless:
187 (i) the associate physician notifies the division within 10 days after the day on which
188 the changes are made; and
189 (ii) the division approves the changes.
190 (d) If the collaborative practice arrangement provides for an associate physician to
191 practice in a medically underserved area:
192 (i) the collaborating physician shall document the completion of at least a two-month
193 period of time during which the associate physician shall practice with the collaborating
194 physician continuously present before practicing in a setting where the collaborating physician
195 is not continuously present; and
196 (ii) the collaborating physician shall document the completion of at least 120 hours in a
197 four-month period by the associate physician during which the associate physician shall
198 practice with the collaborating physician on-site before prescribing a controlled substance
199 when the collaborating physician is not on-site.
200 (2) An associate physician:
201 (a) shall clearly identify himself or herself as an associate physician;
202 (b) is permitted to use the title "doctor" or "Dr."; and
203 (c) if authorized under a collaborative practice arrangement to prescribe Schedule III
204 through V controlled substances, shall register with the United States Drug Enforcement
205 Administration as part of the drug enforcement administration's mid-level practitioner registry.
206 (3) (a) A physician or surgeon licensed and in good standing under Section 58-67-302
207 may enter into a collaborative practice arrangement with an associate physician licensed under
208 Section 58-67-302.8.
209 (b) A physician or surgeon may not enter into a collaborative practice arrangement
210 with more than three full-time equivalent associate physicians.
211 (c) (i) No contract or other agreement shall:
212 (A) require a physician to act as a collaborating physician for an associate physician
213 against the physician's will;
214 (B) deny a collaborating physician the right to refuse to act as a collaborating
215 physician, without penalty, for a particular associate physician; or
216 (C) limit the collaborating physician's ultimate authority over any protocols or standing
217 orders or in the delegation of the physician's authority to any associate physician.
218 (ii) Subsection (3)(c)(i)(C) does not authorize a physician, in implementing protocols,
219 standing orders, or delegation, to violate a hospital's established applicable standards for safe
220 medical practice.
221 (d) A collaborating physician is responsible at all times for the oversight of the
222 activities of, and accepts responsibility for, the primary care services rendered by the associate
223 physician.
224 (4) The division shall makes rules, in consultation with the board, the deans of medical
225 schools in the state, and primary care residency program directors in the state, and in
226 accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, establishing
227 educational methods and programs that:
228 (a) an associate physician shall complete throughout the duration of the collaborative
229 practice arrangement;
230 (b) shall facilitate the advancement of the associate physician's medical knowledge and
231 capabilities; and
232 (c) may lead to credit toward a future residency program.
233 Section 5. Section 58-68-302.5 is amended to read:
234 58-68-302.5. Restricted licensing of an associate physician.
235 (1) An individual may apply for a restricted license as an associate physician if the
236 individual:
237 (a) meets the requirements described in Subsections 58-68-302(1)(a) through (d),
238 (1)(e)(i), and (1)(h) through (k);
239 (b) successfully completes Step 1 and Step 2 of the United States Medical Licensing
240 Examination or the equivalent steps of another board-approved medical licensing examination:
241 (i) within three years after the day on which the applicant graduates from a program
242 described in Subsection 58-68-302(1)(e)(i); and
243 (ii) within two years before applying for a restricted license as an associate physician;
244 and
245 (c) is not currently enrolled in and has not completed a residency program.
246 (2) Before a licensed associate physician may engage in the practice of medicine as
247 described in Subsection (3), the licensed associate physician shall:
248 (a) enter into a collaborative practice arrangement described in Section 58-68-807
249 within six months after the associate physician's initial licensure; and
250 (b) receive division approval of the collaborative practice arrangement.
251 (3) An associate physician's scope of practice is limited to primary care services [
252
253 Section 6. Section 58-68-303 is amended to read:
254 58-68-303. Term of license -- Expiration -- Renewal.
255 (1) (a) The division shall issue each license under this chapter in accordance with a
256 two-year renewal cycle established by division rule.
257 (b) The division may by rule extend or shorten a renewal period by as much as one year
258 to stagger the renewal cycles the division administers.
259 (2) At the time of renewal, the licensee shall:
260 (a) view a suicide prevention video described in Section 58-1-601 and submit proof in
261 the form required by the division;
262 (b) show compliance with continuing education renewal requirements; and
263 (c) show compliance with the requirement for designation of a contact person and
264 alternate contact person for access to medical records and notice to patients as required by
265 Subsections 58-68-304(1)(b) and (c).
266 (3) Each license issued under this chapter expires on the expiration date shown on the
267 license unless renewed in accordance with Section 58-1-308.
268 (4) An individual may not be licensed as an associate physician for more than a total of
269 [
270 Section 7. Section 58-68-807 is amended to read:
271 58-68-807. Collaborative practice arrangement.
272 (1) (a) The division, in consultation with the board, shall make rules in accordance
273 with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, regarding the approval of a
274 collaborative practice arrangement.
275 (b) The division shall require a collaborative practice arrangement to:
276 (i) limit the associate physician to providing primary care services [
277
278 (ii) be consistent with the skill, training, and competence of the associate physician;
279 (iii) specify jointly agreed-upon protocols, or standing orders for the delivery of health
280 care services by the associate physician;
281 (iv) provide complete names, home and business addresses, zip codes, and telephone
282 numbers of the collaborating physician and the associate physician;
283 (v) list all other offices or locations besides those listed in Subsection (1)(b)(iv) where
284 the collaborating physician authorizes the associate physician to prescribe;
285 (vi) require at every office where the associate physician is authorized to prescribe in
286 collaboration with a physician a prominently displayed disclosure statement informing patients
287 that patients may be seen by an associate physician and have the right to see the collaborating
288 physician;
289 (vii) specify all specialty or board certifications of the collaborating physician and all
290 certifications of the associate physician;
291 (viii) specify the manner of collaboration between the collaborating physician and the
292 associate physician, including how the collaborating physician and the associate physician
293 shall:
294 (A) engage in collaborative practice consistent with each professional's skill, training,
295 education, and competence;
296 (B) maintain geographic proximity, except as provided in Subsection (1)(d); and
297 (C) provide oversight of the associate physician during the absence, incapacity,
298 infirmity, or emergency of the collaborating physician;
299 (ix) describe the associate physician's controlled substance prescriptive authority in
300 collaboration with the collaborating physician, including:
301 (A) a list of the controlled substances the collaborating physician authorizes the
302 associate physician to prescribe; and
303 (B) documentation that the authorization to prescribe the controlled substances is
304 consistent with the education, knowledge, skill, and competence of the associate physician and
305 the collaborating physician;
306 (x) list all other written practice arrangements of the collaborating physician and the
307 associate physician;
308 (xi) specify the duration of the written practice arrangement between the collaborating
309 physician and the associate physician; and
310 (xii) describe the time and manner of the collaborating physician's review of the
311 associate physician's delivery of health care services, including provisions that the
312 collaborating physician, or another physician designated in the collaborative practice
313 arrangement, shall review every 14 days:
314 (A) a minimum of 10% of the charts documenting the associate physician's delivery of
315 health care services; and
316 (B) a minimum of 20% of the charts in which the associate physician prescribes a
317 controlled substance, which may be counted in the number of charts to be reviewed under
318 Subsection (1)(b)(xii)(A).
319 (c) An associate physician and the collaborating physician may modify a collaborative
320 practice arrangement, but the changes to the collaborative practice arrangement are not binding
321 unless:
322 (i) the associate physician notifies the division within 10 days after the day on which
323 the changes are made; and
324 (ii) the division approves the changes.
325 (d) If the collaborative practice arrangement provides for an associate physician to
326 practice in a medically underserved area:
327 (i) the collaborating physician shall document the completion of at least a two-month
328 period of time during which the associate physician shall practice with the collaborating
329 physician continuously present before practicing in a setting where the collaborating physician
330 is not continuously present; and
331 (ii) the collaborating physician shall document the completion of at least 120 hours in a
332 four-month period by the associate physician during which the associate physician shall
333 practice with the collaborating physician on-site before prescribing a controlled substance
334 when the collaborating physician is not on-site.
335 (2) An associate physician:
336 (a) shall clearly identify himself or herself as an associate physician;
337 (b) is permitted to use the title "doctor" or "Dr."; and
338 (c) if authorized under a collaborative practice arrangement to prescribe Schedule III
339 through V controlled substances, shall register with the United States Drug Enforcement
340 Administration as part of the drug enforcement administration's mid-level practitioner registry.
341 (3) (a) A physician or surgeon licensed and in good standing under Section 58-68-302
342 may enter into a collaborative practice arrangement with an associate physician licensed under
343 Section 58-68-302.5.
344 (b) A physician or surgeon may not enter into a collaborative practice arrangement
345 with more than three full-time equivalent associate physicians.
346 (c) (i) No contract or other agreement shall:
347 (A) require a physician to act as a collaborating physician for an associate physician
348 against the physician's will;
349 (B) deny a collaborating physician the right to refuse to act as a collaborating
350 physician, without penalty, for a particular associate physician; or
351 (C) limit the collaborating physician's ultimate authority over any protocols or standing
352 orders or in the delegation of the physician's authority to any associate physician.
353 (ii) Subsection (3)(c)(i)(C) does not authorize a physician, in implementing such
354 protocols, standing orders, or delegation, to violate a hospital's established applicable standards
355 for safe medical practice.
356 (d) A collaborating physician is responsible at all times for the oversight of the
357 activities of, and accepts responsibility for, the primary care services rendered by the associate
358 physician.
359 (4) The division shall makes rules, in consultation with the board, the deans of medical
360 schools in the state, and primary care residency program directors in the state, and in
361 accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, establishing
362 educational methods and programs that:
363 (a) an associate physician shall complete throughout the duration of the collaborative
364 practice arrangement;
365 (b) shall facilitate the advancement of the associate physician's medical knowledge and
366 capabilities; and
367 (c) may lead to credit toward a future residency program.