8 LONG TITLE
9 General Description:
10 This bill allows a physician assistant to specialize in mental health care and defines the
11 requirements and scope of practice for this specialization.
12 Highlighted Provisions:
13 This bill:
14 ▸ defines terms;
15 ▸ amends the Mental Health Professional Practice Act to allow a physician assistant
16 who specializes in mental health to engage in the practice of mental health therapy;
17 ▸ describes the qualifications for a physician assistant to specialize in mental health
19 ▸ defines the additional scope of practice for a physician assistant specializing in
20 mental health care; and
21 ▸ makes technical and corresponding changes.
22 Money Appropriated in this Bill:
24 Other Special Clauses:
25 This bill provides a coordination clause.
26 Utah Code Sections Affected:
28 58-60-102, as last amended by Laws of Utah 2013, Chapters 16 and 123
29 58-60-103, as last amended by Laws of Utah 2015, Chapter 258
30 58-60-107, as last amended by Laws of Utah 2013, Chapter 16
31 58-70a-102, as last amended by Laws of Utah 2017, Chapter 309
32 58-70a-201, as last amended by Laws of Utah 2010, Chapter 37
34 58-70a-501.1, Utah Code Annotated 1953
35 58-70a-501.2, Utah Code Annotated 1953
36 Utah Code Sections Affected by Coordination Clause:
37 58-70a-307, Utah Code Annotated 1953
38 58-70a-501.1, Utah Code Annotated 1953
40 Be it enacted by the Legislature of the state of Utah:
41 Section 1. Section 58-60-102 is amended to read:
42 58-60-102. Definitions.
43 In addition to the definitions in Section 58-1-102, as used in this chapter:
44 (1) "Client" or "patient" means an individual who consults or is examined or
45 interviewed by an individual licensed under this chapter who is acting in the individual's
46 professional capacity.
47 (2) "Confidential communication" means information obtained by an individual
48 licensed under this chapter, including information obtained by the individual's examination of
49 the client or patient, which is:
50 (a) (i) transmitted between the client or patient and an individual licensed under this
51 chapter in the course of that relationship; or
52 (ii) transmitted among the client or patient, an individual licensed under this chapter,
53 and individuals who are participating in the diagnosis or treatment under the direction of an
54 individual licensed under this chapter, including members of the client's or patient's family; and
55 (b) made in confidence, for the diagnosis or treatment of the client or patient by the
56 individual licensed under this chapter, and by a means not intended to be disclosed to third
57 persons other than those individuals:
58 (i) present to further the interest of the client or patient in the consultation,
59 examination, or interview;
60 (ii) reasonably necessary for the transmission of the communications; or
61 (iii) participating in the diagnosis and treatment of the client or patient under the
62 direction of the mental health therapist.
63 (3) "Hypnosis" means, when referring to individuals exempted from licensure under
64 this chapter, a process by which an individual induces or assists another individual into a
65 hypnotic state without the use of drugs or other substances and for the purpose of increasing
66 motivation or to assist the individual to alter lifestyles or habits.
67 (4) "Individual" means a natural person.
68 (5) "Mental health therapist" means an individual who is practicing within the scope of
69 practice defined in the individual's respective licensing act and is licensed under this title as:
70 (a) a physician and surgeon, or osteopathic physician engaged in the practice of mental
71 health therapy;
72 (b) an advanced practice registered nurse, specializing in psychiatric mental health
74 (c) an advanced practice registered nurse intern, specializing in psychiatric mental
75 health nursing;
76 (d) a psychologist qualified to engage in the practice of mental health therapy;
77 (e) a certified psychology resident qualifying to engage in the practice of mental health
79 (f) a physician assistant specializing in mental health care under Section 58-70a-501.1;
86 (6) "Mental illness" means a mental or emotional condition defined in an approved
87 diagnostic and statistical manual for mental disorders generally recognized in the professions of
88 mental health therapy listed under Subsection (5).
89 (7) "Practice of mental health therapy" means treatment or prevention of mental illness,
90 whether in person or remotely, including:
91 (a) conducting a professional evaluation of an individual's condition of mental health,
92 mental illness, or emotional disorder consistent with standards generally recognized in the
93 professions of mental health therapy listed under Subsection (5);
94 (b) establishing a diagnosis in accordance with established written standards generally
95 recognized in the professions of mental health therapy listed under Subsection (5);
96 (c) prescribing a plan for the prevention or treatment of a condition of mental illness or
97 emotional disorder; and
98 (d) engaging in the conduct of professional intervention, including psychotherapy by
99 the application of established methods and procedures generally recognized in the professions
100 of mental health therapy listed under Subsection (5).
101 (8) "Remotely" means communicating via Internet, telephone, or other electronic
102 means that facilitate real-time audio or visual interaction between individuals when they are not
103 physically present in the same room at the same time.
104 (9) "Unlawful conduct" is as defined in Sections 58-1-501 and 58-60-109.
105 (10) "Unprofessional conduct" is as defined in Sections 58-1-501 and 58-60-110, and
106 may be further defined by division rule.
107 Section 2. Section 58-60-103 is amended to read:
108 58-60-103. Licensure required.
109 (1) (a) An individual shall be licensed under:
110 (i) this chapter;
111 (ii) Chapter 67, Utah Medical Practice Act;
112 (iii) Chapter 68, Utah Osteopathic Medical Practice Act;
113 (iv) Chapter 31b, Nurse Practice Act;
114 (v) Chapter 61, Psychologist Licensing Act;
115 (vi) Chapter 70a, Utah Physician Assistant Act; or
116 (vii) exempted from licensure under this chapter [
117 (b) Only an individual described in Subsection (1)(a) may:
119 health therapy, clinical social work, certified social work, marriage and family therapy, or
120 clinical mental health counseling; or
122 clinical social worker, certified social worker, marriage and family therapist, clinical mental
123 health counselor, psychiatrist, psychologist, registered psychiatric mental health nurse
124 specialist, certified psychology resident, associate marriage and family therapist, or associate
125 clinical mental health counselor.
126 (2) An individual shall be licensed under this chapter or exempted from licensure under
127 this chapter in order to:
128 (a) engage in, or represent that the individual is engaged in, practice as a social service
129 worker; or
130 (b) represent that the individual is, or use the title of, a social service worker.
131 (3) An individual shall be licensed under this chapter or exempted from licensure under
132 this chapter in order to:
133 (a) engage in, or represent that the individual is engaged in, practice as a substance use
134 disorder counselor; or
135 (b) represent that the individual is, or use the title of, a substance use disorder
137 (4) Notwithstanding the provisions of Subsection 58-1-307(1)(c), an individual shall be
138 certified under this chapter, or otherwise exempted from licensure under this chapter, in order
139 to engage in an internship or residency program of supervised clinical training necessary to
140 meet the requirements for licensure as:
141 (a) a marriage and family therapist under Part 3, Marriage and Family Therapist
142 Licensing Act; or
143 (b) a clinical mental health counselor under Part 4, Clinical Mental Health Counselor
144 Licensing Act.
145 Section 3. Section 58-60-107 is amended to read:
146 58-60-107. Exemptions from licensure.
147 (1) Except as modified in Section 58-60-103, the exemptions from licensure in Section
148 58-1-307 apply to this chapter.
149 (2) In addition to the exemptions from licensure in Section 58-1-307, the following
150 may engage in acts included within the definition of practice as a mental health therapist,
151 subject to the stated circumstances and limitations, without being licensed under this chapter:
152 (a) the following when practicing within the scope of the license held:
153 (i) a physician and surgeon or osteopathic physician and surgeon licensed under
154 Chapter 67, Utah Medical Practice Act, or Chapter 68, Utah Osteopathic Medical Practice Act;
155 (ii) an advanced practice registered nurse, specializing in psychiatric mental health
156 nursing, licensed under Chapter 31b, Nurse Practice Act; [
157 (iii) a psychologist licensed under Chapter 61, Psychologist Licensing Act; and
158 (iv) a physician assistant licensed under Chapter 70a, Utah Physician Assistant Act,
159 and specializing in mental health care under Section 58-70a-501.1;
160 (b) a recognized member of the clergy while functioning in a ministerial capacity as
161 long as the member of the clergy does not represent that the member of the clergy is, or use the
162 title of, a license classification in Subsection 58-60-102(5);
163 (c) an individual who is offering expert testimony in a proceeding before a court,
164 administrative hearing, deposition upon the order of a court or other body having power to
165 order the deposition, or a proceeding before a master, referee, or alternative dispute resolution
167 (d) an individual engaged in performing hypnosis who is not licensed under this title in
168 a profession which includes hypnosis in its scope of practice, and who:
169 (i) (A) induces a hypnotic state in a client for the purpose of increasing motivation or
170 altering lifestyles or habits, such as eating or smoking, through hypnosis;
171 (B) consults with a client to determine current motivation and behavior patterns;
172 (C) prepares the client to enter hypnotic states by explaining how hypnosis works and
173 what the client will experience;
174 (D) tests clients to determine degrees of suggestibility;
175 (E) applies hypnotic techniques based on interpretation of consultation results and
176 analysis of client's motivation and behavior patterns; and
177 (F) trains clients in self-hypnosis conditioning;
178 (ii) may not:
179 (A) engage in the practice of mental health therapy;
180 (B) use the title of a license classification in Subsection 58-60-102(5); or
181 (C) use hypnosis with or treat a medical, psychological, or dental condition defined in
182 generally recognized diagnostic and statistical manuals of medical, psychological, or dental
184 (e) an individual's exemption from licensure under Subsection 58-1-307(1)(b)
185 terminates when the student's training is no longer supervised by qualified faculty or staff and
186 the activities are no longer a defined part of the degree program;
187 (f) an individual holding an earned doctoral degree or master's degree in social work,
188 marriage and family therapy, or clinical mental health counseling, who is employed by an
189 accredited institution of higher education and who conducts research and teaches in that
190 individual's professional field, but only if the individual does not engage in providing or
191 supervising professional services regulated under this chapter to individuals or groups
192 regardless of whether there is compensation for the services;
193 (g) an individual in an on-the-job training program approved by the division while
194 under the supervision of qualified persons;
195 (h) an individual providing general education in the subjects of alcohol, drug use, or
196 substance use disorders, including prevention;
197 (i) an individual providing advice or counsel to another individual in a setting of their
198 association as friends or relatives and in a nonprofessional and noncommercial relationship, if
199 there is no compensation paid for the advice or counsel; and
200 (j) an individual who is licensed, in good standing, to practice mental health therapy or
201 substance use disorder counseling in a state or territory of the United States outside of Utah
202 may provide short term transitional mental health therapy remotely or short term transitional
203 substance use disorder counseling remotely to a client in Utah only if:
204 (i) the individual is present in the state or territory where the individual is licensed to
205 practice mental health therapy or substance use disorder counseling;
206 (ii) the client relocates to Utah;
207 (iii) the client is a client of the individual immediately before the client relocates to
209 (iv) the individual provides the short term transitional mental health therapy or short
210 term transitional substance use disorder counseling remotely to the client only during the 45
211 day period beginning on the day on which the client relocates to Utah;
212 (v) within 10 days after the day on which the client relocates to Utah, the individual
213 provides written notice to the division of the individual's intent to provide short term
214 transitional mental health therapy or short term transitional substance use disorder counseling
215 remotely to the client; and
216 (vi) the individual does not engage in unlawful conduct or unprofessional conduct.
217 Section 4. Section 58-70a-102 is amended to read:
218 58-70a-102. Definitions.
219 In addition to the definitions in Section 58-1-102, as used in this chapter:
220 (1) "Board" means the Physician Assistant Licensing Board created in Section
222 (2) (a) "Delegation of services agreement" means written criteria jointly developed by a
223 physician assistant's supervising physician and substitute supervising physicians and the
224 physician assistant, that permits a physician assistant, working under the direction or review of
225 the supervising physician, to assist in the management of common illnesses and injuries.
226 (b) The agreement defines the working relationship and delegation of duties between
227 the supervising physician and the physician assistant as specified by division rule and shall
229 (i) the prescribing of controlled substances;
230 (ii) the degree and means of supervision;
231 (iii) the frequency and mechanism of quality review, including the mechanism for
232 review of patient data and documentation of the review, as determined by the supervising
233 physician and the physician assistant;
234 (iv) procedures addressing situations outside the scope of practice of the physician
235 assistant; and
236 (v) procedures for providing backup for the physician assistant in emergency situations.
237 (3) "Direct supervision" means the supervising physician is:
238 (a) physically present at the point of patient treatment on site where the physician
239 assistant he is supervising is practicing; and
240 (b) immediately available for consultation with the physician assistant.
241 (4) "Mental health therapist" means the same as that term is defined in Section
244 (a) the professional activities and conduct of a physician assistant, also known as a PA,
245 in diagnosing, treating, advising, or prescribing for any human disease, ailment, injury,
246 infirmity, deformity, pain, or other condition, dependent upon and under the supervision of a
247 supervising physician or substitute supervising physician in accordance with a delegation of
248 services agreement; and
249 (b) the physician assistant acts as the agent of the supervising physician or substitute
250 supervising physician when acting in accordance with a delegation of services agreement.
251 (6) "Practice of mental health therapy" means the same as that term is defined in
252 Section 58-60-102.
254 requirements of a supervising physician under this chapter and acts as the supervising physician
255 in the absence of the supervising physician.
257 (a) is currently licensed to practice under Title 58, Chapter 67, Utah Medical Practice
258 Act, or Title 58, Chapter 68, Utah Osteopathic Medical Practice Act;
259 (b) acts as the primary supervisor of a physician assistant and takes responsibility for
260 the professional practice and conduct of a physician assistant in accordance with this chapter;
262 (c) is not an employee of the physician assistant whom the individual supervises.
264 with the physician assistant, either personally or by other means permitting direct verbal
265 communication between the physician and the physician assistant.
267 58-1-501 and 58-70a-502.
269 (a) as defined in Sections 58-1-501 and 58-70a-503; and [
271 (b) as further defined by the division by rule.
272 Section 5. Section 58-70a-201 is amended to read:
273 58-70a-201. Board.
274 (1) There is created the Physician Assistant Licensing Board, which consists of seven
276 (a) three licensed physicians[
278 psychiatrist, who currently work or have previously worked collaboratively with a physician
280 (b) three physician assistants, one of whom is involved in the administration of an
281 approved physician assistant education program within the state; and
282 (c) one person from the general public.
283 (2) The board shall be appointed and serve in accordance with Section 58-1-201.
284 (3) The duties and responsibilities of the board are in accordance with Sections
285 58-1-202 and 58-1-203. In addition, the board shall designate one of its members on a
286 permanent or rotating basis to:
287 (a) assist the division in reviewing complaints concerning the unlawful or
288 unprofessional conduct of a licensee; and
289 (b) advise the division in its investigation of these complaints.
290 (4) A board member who has, under Subsection (3), reviewed a complaint or advised
291 in its investigation may be disqualified from participating with the board when the board serves
292 as a presiding officer in an adjudicative proceeding concerning the complaint. The board
293 member may be disqualified:
294 (a) on the member's own motion, due to actual or perceived bias or lack of objectivity;
296 (b) upon challenge for cause raised on the record by any party to the adjudicative
298 Section 6. Section 58-70a-501.1 is enacted to read:
299 58-70a-501.1. Qualifications for a physician assistant specializing in mental health
300 care -- Rulemaking.
301 (1) A physician assistant specializing in mental health care under this section shall:
302 (a) hold a valid license as a physician assistant under this chapter;
303 (b) obtain and maintain a Certification of Added Qualification in psychiatry issued by
304 the National Commission on Certification of Physician Assistants;
305 (c) complete:
306 (i) an accredited doctorate level academic program for physician assistants approved by
307 the division in collaboration with the board;
308 (ii) a post-graduate certificate program for physician assistants to practice within
309 psychiatric and mental health care that is approved by the division in collaboration with the
310 board; or
311 (iii) a post-graduate residency in psychiatry and additional clinical practice or
312 coursework in accordance with requirements approved by the division in collaboration with the
313 board; and
314 (d) complete the clinical practice requirement described in Subsection (4).
315 (2) The division, in collaboration with the board, may approve a program under
316 Subsections (1)(c)(i) and (ii), if the program:
317 (a) is an accredited doctoral level or post-graduate academic program;
318 (b) includes at least 1,600 hours of accredited instructional hours that results in:
319 (i) a doctorate degree or equivalent; or
320 (ii) a graduate level certification in psychiatric mental health; and
321 (c) provides graduate level instruction in:
322 (i) at least 2 credit hours or equivalent of neuroscience;
323 (ii) health care law and ethics;
324 (iii) health care delivery;
325 (iv) evidence-based mental health medicine;
326 (v) evidence-based mental health research;
327 (vi) at least 3 credit hours or equivalent of psychotherapy;
328 (vii) psychiatric assessment;
329 (viii) crisis intervention;
330 (ix) group and family therapy;
331 (x) suicide risk assessment;
332 (xi) violence risk assessment;
333 (xii) at least 3 credit hours or equivalent of psychopharmacology;
334 (xiii) a comprehensive review of mental disorders as characterized by the current
335 Diagnostic and Statistical Manual of Mental Disorders, including diagnostic criteria and
336 prevalence; and
337 (xiv) medical and therapeutic management of each condition across the lifespan in
338 diverse populations and in a variety of clinical settings.
339 (3) The division, in collaboration with the board, may:
340 (a) approve and accept the completion of a post-graduate residency in psychiatry under
341 Subsection (1)(c)(iii) if the residency includes clinical and academic training that is
342 substantially equivalent to the training described in Subsections (2)(b) and (c); and
343 (b) require the completion of additional coursework or clinical hours for an individual
344 who meets the training requirement under Subsection (1)(c) through a post-graduate residency
345 in psychiatry.
346 (4) (a) A physician assistant specializing in mental health care under this section shall
347 complete 10,000 hours of clinical practice in mental health.
348 (b) The clinical practice hours described in Subsection (4)(a) shall be completed after
349 the individual passes the Physician Assistant National Certifying Exam administered by the
350 National Commission on Certification of Physician Assistants.
351 (c) Up to 1,000 hours of clinical practice under Subsection (4)(a) may be completed as
352 part of an approved education program in mental health if the clinical practice hours meet the
353 requirements described in Subsection (4)(d).
354 (d) (i) At least the first 4,000 hours of the clinical practice hours described in
355 Subsection (4)(a) shall be completed under the supervision of a psychiatrist.
356 (ii) At least 2,000 hours of the clinical practice hours described in Subsection (4)(a)
357 shall be completed in psychotherapy under the supervision of a mental health therapist or a
358 psychiatrist who has been trained in and has at least two years of practice experience in
360 (iii) The remaining clinical practice hours required under Subsection (4)(a) and not
361 received under Subsections (4)(d)(i) and (ii) shall be completed in collaboration with a
363 (5) The division, in collaboration with the board, shall establish continuing education
364 requirements for a physician assistant specializing in mental health care under this section.
365 Section 7. Section 58-70a-501.2 is enacted to read:
366 58-70a-501.2. Scope of practice for a physician assistant specializing in mental
367 health care.
368 (1) (a) A physician assistant specializing in mental health care under Section
369 58-70a-501.1 may engage in the practice of mental health therapy consistent with the physician
370 assistant's education, experience, and competence.
371 (b) Section 58-70a-501 applies to a physician assistant specializing in mental health
372 care in addition to this section.
373 (2) A physician assistant specializing in mental health care is responsible for meeting
374 the local standards of care in the provision of services, including mental health therapy and
376 (3) (a) Except as provided in Subsection (3)(b), a physician assistant specializing in
377 mental health care may administer a behavioral health screening instrument.
378 (b) A physician assistant specializing in mental health care may not perform a
379 psychological or neuropsychological assessment or evaluation, including:
380 (i) an intellectual assessment;
381 (ii) a forensic assessment or evaluation; and
382 (iii) administration of a psychological or neuropsychological test or instrument that
383 requires qualification level B or qualification level C under the Standards for Educational and
384 Psychological Testing approved as policy by the American Psychological Association.
385 (4) (a) A physician assistant may not administer neurostimulation or neuromodulation.
386 (b) Subsection (4)(a) does not apply to neurostimulation or neuromodulation
387 administered by a physician assistant:
388 (i) in a health care facility; and
389 (ii) under supervision of a physician whose usual scope of practice includes
390 neurostimulation or neuromodulation.
391 (5) As a condition of probation or reinstatement of a license, the division may require
392 that, for a specified duration, a physician assistant specializing in mental health care
393 collaborate with or practice under the supervision of a physician who is board certified in
395 (6) A physician assistant who is in the process of completing the clinical training
396 requirement in Subsection 58-70a-501.1(1)(d), may engage in the practice of mental health
397 therapy if the physician assistant:
398 (a) meets the requirements described in Subsections 58-70a-501.1(1)(a) through (c);
399 (b) engages in the practice of mental health therapy under the supervision of:
400 (i) a mental health therapist who has been trained in and has at least two years of
401 practice experience in psychotherapy; or
402 (ii) a physician who is board certified in psychiatry; and
403 (c) engages in the practice of mental health therapy in accordance with rules made by
404 the division regarding the supervision described in Subsection (6)(b).
405 Section 8. Coordinating S.B. 28 with S.B. 27 -- Omitting substantive changes --
406 Substantive amendments.
407 (1) It is the intent of the Legislature that this S.B. 28 shall only take effect if S.B. 27,
408 Physician Assistant Act Amendments, passes and becomes law.
409 (2) If this S.B. 28 and S.B. 27, Physician Assistant Act Amendments, both pass and
410 become law, it is the intent of the Legislature that:
411 (a) Subsection 58-70a-307(2)(c) shall be amended to read:
412 "(c) except as provided in Subsection 58-70a-501.1(4)(d) for a physician assistant
413 specializing in mental health care, engage in collaboration with a physician for the first 4,000
414 hours of the physician assistant's post-graduate clinical practice experience.";
415 (b) Subsection 58-70a-307(3)(a) shall be amended to read:
416 "(3) (a) Except as provided in Subsection 58-70a-501.1(4)(d) for a physician assistant
417 specializing in mental health care, a physician assistant who has more than 4,000 hours of
418 practice experience and less than 10,000 hours of practice experience shall enter into a written
419 collaborative agreement with:
420 (i) a physician; or
421 (ii) a licensed physician assistant with more than 10,000 hours of practice experience in
422 the same specialty as the physician assistant.";
423 (c) Subsection 58-70a-501.1(4)(d)(iii) shall be amended to read:
424 "(iii) The remaining clinical practice hours required under Subsection (4)(a) and not
425 received under Subsections (4)(d)(i) and (ii) shall be completed in collaboration as defined in
426 Section 58-70a-307 with a psychiatrist."; and
427 (d) the Office of Legislative Research and General Counsel prepare the Utah Code
428 database for publication in accordance with Subsections (1) and (2) of this coordination clause.