Senator Curtis S. Bramble proposes the following substitute bill:


1     
PHYSICIAN ASSISTANT ACT AMENDMENTS

2     
2021 GENERAL SESSION

3     
STATE OF UTAH

4     
Chief Sponsor: Curtis S. Bramble

5     
House Sponsor: James A. Dunnigan

6     

7     LONG TITLE
8     General Description:
9          This bill amends provisions relating to the practice of a physician assistant.
10     Highlighted Provisions:
11          This bill:
12          ▸     amends the scope of practice for a physician assistant;
13          ▸     removes the requirement that a physician assistant maintain a specific relationship
14     with a physician or any other health care provider;
15          ▸     enacts and amends provisions relating to practice as a physician assistant;
16          ▸     creates requirements for newly graduated physician assistants;
17          ▸     permits a physician assistant to respond during a health care emergency or disaster;
18     and
19          ▸     makes technical and corresponding changes.
20     Money Appropriated in this Bill:
21          None
22     Other Special Clauses:
23          None
24     Utah Code Sections Affected:
25     AMENDS:
26          58-70a-102, as last amended by Laws of Utah 2017, Chapter 309
27          58-70a-201, as last amended by Laws of Utah 2010, Chapter 37
28          58-70a-302, as last amended by Laws of Utah 2020, Chapter 339
29          58-70a-305, as last amended by Laws of Utah 2019, Chapter 349
30          58-70a-306, as last amended by Laws of Utah 2020, Chapter 339
31          58-70a-501, as last amended by Laws of Utah 2017, Chapter 309
32          58-70a-502, as last amended by Laws of Utah 2014, Chapter 72
33          58-70a-503, as last amended by Laws of Utah 2020, Chapter 25
34     ENACTS:
35          58-70a-307, Utah Code Annotated 1953
36          58-70a-507, Utah Code Annotated 1953
37     

38     Be it enacted by the Legislature of the state of Utah:
39          Section 1. Section 58-70a-102 is amended to read:
40          58-70a-102. Definitions.
41          In addition to the definitions in Section 58-1-102, as used in this chapter:
42          (1) "Board" means the Physician Assistant Licensing Board created in Section
43     58-70a-201.
44          [(2) (a) "Delegation of services agreement" means written criteria jointly developed by
45     a physician assistant's supervising physician and substitute supervising physicians and the
46     physician assistant, that permits a physician assistant, working under the direction or review of
47     the supervising physician, to assist in the management of common illnesses and injuries.]
48          [(b) The agreement defines the working relationship and delegation of duties between
49     the supervising physician and the physician assistant as specified by division rule and shall
50     include:]
51          [(i) the prescribing of controlled substances;]
52          [(ii) the degree and means of supervision;]
53          [(iii) the frequency and mechanism of quality review, including the mechanism for
54     review of patient data and documentation of the review, as determined by the supervising
55     physician and the physician assistant;]
56          [(iv) procedures addressing situations outside the scope of practice of the physician
57     assistant; and]
58          [(v) procedures for providing backup for the physician assistant in emergency
59     situations.]
60          [(3) "Direct supervision" means the supervising physician is:]
61          [(a) physically present at the point of patient treatment on site where the physician
62     assistant he is supervising is practicing; and]
63          [(b) immediately available for consultation with the physician assistant.]
64          (2) "Competence" means possessing the requisite cognitive, non-cognitive, and
65     communicative abilities and qualities to perform effectively within the scope of practice of the
66     physician assistant's practice while adhering to professional and ethical standards.
67          (3) "Health care facility" means the same as that term is defined in Section 26-21-2.
68          (4) "Physician" means the same as that term is defined in Section 58-67-102.
69          (5) "Physician assistant" means an individual who is licensed to practice under this
70     chapter.
71          [(4)] (6) "Practice as a physician assistant" means[:(a) ] the professional activities and
72     conduct of a physician assistant, also known as a PA, in diagnosing, treating, advising, or
73     prescribing for any human disease, ailment, injury, infirmity, deformity, pain, or other
74     condition[, dependent upon and under the supervision of a supervising physician or substitute
75     supervising physician in accordance with a delegation of services agreement; and] under the
76     provisions of this chapter.
77          [(b) the physician assistant acts as the agent of the supervising physician or substitute
78     supervising physician when acting in accordance with a delegation of services agreement.]
79          [(5) "Substitute supervising physician" means an individual who meets the
80     requirements of a supervising physician under this chapter and acts as the supervising physician
81     in the absence of the supervising physician.]
82          [(6) "Supervising physician" means an individual who:]
83          [(a) is currently licensed to practice under Title 58, Chapter 67, Utah Medical Practice
84     Act, or Title 58, Chapter 68, Utah Osteopathic Medical Practice Act;]
85          [(b) acts as the primary supervisor of a physician assistant and takes responsibility for
86     the professional practice and conduct of a physician assistant in accordance with this chapter;
87     and]
88          [(c) is not an employee of the physician assistant whom the individual supervises.]
89          [(7) "Supervision" means the supervising physician is available for consultation with
90     the physician assistant, either personally or by other means permitting direct verbal
91     communication between the physician and the physician assistant.]
92          [(8)] (7) "Unlawful conduct" means the same as that term is [as] defined in Sections
93     58-1-501 and 58-70a-502.
94          [(9)] (8) "Unprofessional conduct" [is] means "unprofessional conduct":
95          (a) as defined in Sections 58-1-501 and 58-70a-503; and [as may be further defined by
96     rule.]
97          (b) as further defined by the division by rule.
98          Section 2. Section 58-70a-201 is amended to read:
99          58-70a-201. Board.
100          (1) There is created the Physician Assistant Licensing Board, which consists of seven
101     members:
102          (a) three licensed physicians[, at least two of whom are individuals who are supervising
103     or who have supervised a physician assistant] who currently work or have previously worked
104     collaboratively with a physician assistant;
105          (b) three physician assistants, one of whom is involved in the administration of an
106     approved physician assistant education program within the state; and
107          (c) one person from the general public.
108          (2) The board shall be appointed and serve in accordance with Section 58-1-201.
109          (3) (a) The duties and responsibilities of the board are in accordance with Sections
110     58-1-202 and 58-1-203. [In addition, the]
111          (b) The board shall designate one of its members on a permanent or rotating basis to:
112          [(a)] (i) assist the division in reviewing complaints concerning the unlawful or
113     unprofessional conduct of a licensee; and
114          [(b)] (ii) advise the division in [its] the division's investigation of these complaints.
115          (4) (a) A board member who has, under Subsection (3), reviewed a complaint or
116     advised in its investigation may be disqualified from participating with the board when the
117     board serves as a presiding officer in an adjudicative proceeding concerning the complaint.
118          (b) The board member described in Subsection (4)(a) may be disqualified:
119          [(a)] (i) on the member's own motion, due to actual or perceived bias or lack of
120     objectivity; or
121          [(b)] (ii) upon challenge for cause raised on the record by any party to the adjudicative
122     proceeding.
123          Section 3. Section 58-70a-302 is amended to read:
124          58-70a-302. Qualifications for licensure.
125          Each applicant for licensure as a physician assistant shall:
126          (1) submit an application in a form prescribed by the division;
127          (2) pay a fee determined by the department under Section 63J-1-504;
128          (3) have successfully completed a physician assistant program accredited by [the]:
129          (a) the Accreditation Review Commission on Education for the Physician Assistant; or
130          (b) if prior to January 1, 2001, either the:
131          (i) Committee on Accreditation of Allied Health Education Programs; or
132          (ii) Committee on Allied Health Education and Accreditation;
133          (4) have passed the licensing examinations required by division rule made in
134     collaboration with the board; and
135          (5) meet with the board and representatives of the division, if requested, for the
136     purpose of evaluating the applicant's qualifications for licensure[; and].
137          [(6) (a) if the applicant desires to practice in Utah, complete a form provided by the
138     division indicating:]
139          [(i) the applicant has completed a delegation of services agreement signed by the
140     physician assistant and the supervising physician; and]
141          [(ii) the agreement is on file at the Utah practice sites; or]
142          [(b) complete a form provided by the division indicating the applicant is not practicing
143     in Utah and, prior to practicing in Utah, the applicant will meet the requirements of Subsection
144     (6)(a).]
145          Section 4. Section 58-70a-305 is amended to read:
146          58-70a-305. Exemptions from licensure.
147          (1) In addition to the exemptions from licensure in Section 58-1-307,[ the following
148     persons] an individual described in Subsection (2) may engage in acts included within the
149     definition of practice as a physician assistant, subject to the stated circumstances and
150     limitations, without being licensed under this chapter[:].
151          [(1)] (2) Subsection (1) applies to a student enrolled in an accredited physician
152     assistant education program while engaged in activities as a physician assistant:
153          (a) that are a part of the education program;
154          (b) that are conducted at an affiliated medical facility under the direct supervision of a:
155          (i) physician associated with the program; or
156          (ii) licensed physician assistant associated with the medical faculty; and
157          (c) for which the program accepts in writing the responsibility for the student[; and].
158          [(2) a "medical assistant," as defined in Sections 58-67-102 and 58-68-102, who:]
159          [(a) does not diagnose, advise, independently treat, or prescribe to or on behalf of any
160     person; and]
161          [(b) for whom the supervising physician accepts responsibility.]
162          Section 5. Section 58-70a-306 is amended to read:
163          58-70a-306. Temporary license.
164          (1) An applicant for licensure as a physician assistant who has met all qualifications for
165     licensure except passing an examination component as required in Section 58-70a-302, may
166     apply for and be granted a temporary license to practice under Subsection (2).
167          (2) (a) The applicant shall submit to the division evidence of completion of a physician
168     assistant program as defined in Subsection 58-70a-302(3).
169          (b) (i) The temporary license shall be issued for a period not to exceed 120 days to
170     allow the applicant to pass the Physician Assistant National Certifying Examination.
171          (ii) The temporary license may not be renewed or extended.
172          [(c) A physician assistant holding a temporary license may work only under the direct
173     supervision of an approved supervising or substitute supervising physician in accordance with
174     a delegation of services agreement, and all patient charts shall be reviewed and countersigned
175     by the supervising or substitute supervising physician.]
176          (c) A temporary license holder shall work under the direct supervision of a physician.
177          Section 6. Section 58-70a-307 is enacted to read:
178          58-70a-307. Collaboration requirements -- Clinical practice experience --
179     Requirements for independent practice in a new specialty.
180          (1) As used in this section, "collaboration" means the interaction and relationship that a
181     physician assistant has with one or more physicians in which:
182          (a) the physician assistant and physician are cognizant of the physician assistant's
183     qualifications and limitations in caring for patients;
184          (b) the physician assistant, while responsible for care that the physician assistant
185     provides, consults with the physician or physicians regarding patient care; and
186          (c) the physician or physicians give direction and guidance to the physician assistant.
187          (2) A physician assistant with less than 10,000 hours of post-graduate clinical practice
188     experience shall:
189          (a) practice under written policies and procedures established at a practice level that:
190          (i) describe how collaboration will occur in accordance with this section and
191     Subsections 58-70a-501(2) and (3);
192          (ii) describe methods for evaluating the physician assistant's competency, knowledge,
193     and skills;
194          (b) provide a copy of the written policies and procedures and documentation of
195     compliance with this Subsection (2) to the board upon the board's request; and
196          (c) engage in collaboration with a physician for the first 4,000 hours of the physician
197     assistant's post-graduate clinical practice experience.
198          (3) (a) A physician assistant who has more than 4,000 hours of practice experience and
199     less than 10,000 hours of practice experience shall enter into a written collaborative agreement
200     with:
201          (i) a physician; or
202          (ii) a licensed physician assistant with more than 10,000 hours of practice experience in
203     the same specialty as the physician assistant.
204          (b) The collaborative agreement described in Subsection (3)(a) shall:
205          (i) describe how collaboration under this section and Subsections 58-70a-501(2) and
206     (3) will occur;
207          (ii) be kept on file at the physician assistant's practice location; and
208          (iii) be provided by the physician assistant to the board upon the board's request.
209          (4) A physician assistant who wishes to change specialties to another specialty in
210     which the PA has less than 4,000 hours of experience shall engage in collaboration for a
211     minimum of 4,000 hours with a physician who is trained and experienced in the specialty to
212     which the physician assistant is changing.
213          Section 7. Section 58-70a-501 is amended to read:
214          58-70a-501. Scope of practice.
215          (1) A physician assistant may provide any medical services that are not specifically
216     prohibited under this chapter or rules adopted under this chapter, and that are[:(a) ] within the
217     physician assistant's skills and scope of competence[;].
218          [(b) within the usual scope of practice of the physician assistant's supervising
219     physician; and]
220          [(c) provided under the supervision of a supervising physician and in accordance with a
221     delegation of services agreement.]
222          (2) A physician assistant shall consult, collaborate with, and refer to appropriate
223     members of the health care team:
224          (a) as indicated by the patient's condition;
225          (b) based on the physician assistant's education, experience, and competencies;
226          (c) the applicable standard of care; and
227          (d) if applicable, in accordance with the requirements described in Section 58-70a-307.
228          (3) Subject to Section 58-70a-307, the degree of collaboration under Subsection (2):
229          (a) shall be determined at the physician assistant's practice, including decisions made
230     by the physician assistant's:
231          (i) employer;
232          (ii) group;
233          (iii) hospital service; or
234          (iv) health care facility credentialing and privileging system; and
235          (b) may also be determined by a managed care organization with whom the physician
236     assistant is a network provider.
237          (4) A physician assistant may only provide healthcare services:
238          (a) for which the physician assistant has been trained and credentialed, privileged, or
239     authorized to perform; and
240          (b) that are within the physician assistant's practice specialty.
241          (5) A physician assistant may authenticate through a signature, certification, stamp,
242     verification, affidavit, or endorsement any document that may be authenticated by a physician
243     and that is within the physician assistant's scope of practice.
244          (6) A physician assistant is responsible for the care that the physician assistant
245     provides.
246          (7) (a) As used in this Subsection (7):
247          (i) "ALS/ACLS certification" means a certification:
248          (A) in advanced life support by the American Red Cross;
249          (B) in advanced cardiac life support by the American Heart Association; or
250          (C) that is equivalent to a certification described in Subsection (7)(a)(i)(A) or (B).
251          (ii) "Minimal sedation anxiolysis" means creating a drug induced state:
252          (A) during which a patient responds normally to verbal commands;
253          (B) which may impair cognitive function and physical coordination; and
254          (C) which does not affect airway, reflexes, or ventilatory and cardiovascular function.
255          (b) Except as provided in Subsections (c) through (e), a physician assistant may not
256     administer general anesthetics.
257          (c) A physician assistant may perform minimal sedation anxiolysis if the procedure is
258     within the physician assistant's scope of practice.
259          (d) A physician assistant may perform rapid sequence induction for intubation of a
260     patient if:
261          (i) the procedure is within the physician assistant's scope of practice;
262          (ii) the physician assistant holds a valid ALS/ACLS certification and is credentialed
263     and privileged at the hospital where the procedure is performed; and
264          (iii) (A) a qualified physician is not available and able to perform the procedure; or
265          (B) the procedure is performed by the physician assistant under supervision of or
266     delegation by a physician.
267          (e) Subsection (7)(b) does not apply to anesthetics administered by a physician
268     assistant:
269          (i) in an intensive care unit of a hospital;
270          (ii) for the purpose of enabling a patient to tolerate ventilator support or intubation; and
271          (iii) under supervision of or delegation by a physician whose usual scope of practice
272     includes the procedure.
273          [(2)] (8) (a) A physician assistant[, in accordance with a delegation of services
274     agreement,] may prescribe or administer an appropriate controlled substance that is within the
275     physician assistant's scope of practice if[: (a) ] the physician assistant holds a Utah controlled
276     substance license and a DEA registration[; and].
277          [(b) the prescription or administration of the controlled substance is within the
278     prescriptive practice of the supervising physician and also within the delegated prescribing
279     stated in the delegation of services agreement.]
280          (b) A physician assistant may prescribe, order, administer, and procure a drug or
281     medical device that is within the physician assistant's scope of practice.
282          (c) A physician assistant may dispense a drug if dispensing the drug:
283          (i) is permitted under Title 58, Chapter 17b, Pharmacy Practice Act; and
284          (ii) is within the physician assistant's scope of practice.
285          (9) A physician assistant practicing independently may only perform or provide a
286     health care service that:
287          (a) is appropriate to perform or provide outside of a health care facility; and
288          (b) the physician assistant has been trained and credentialed or authorized to provide or
289     perform independently without physician supervision.
290          [(3)] (10) A physician assistant [shall], while practicing as a physician assistant[,]:
291          (a) shall wear an identification badge showing the physician assistant's license
292     classification as a physician assistant[.];
293          [(4) A physician assistant may not:]
294          [(a) independently charge or bill a patient, or others on behalf of the patient, for
295     services rendered;]
296          [(b) identify himself or herself]
297          (b) shall identify themselves to a patient as a physician assistant; and
298          (c) may not identify themselves to any person in connection with activities allowed
299     under this chapter other than as a physician assistant[;] or PA.
300          [(c) use the title "doctor" or "physician," or by any knowing act or omission lead or
301     permit anyone to believe the physician assistant is a physician.]
302          Section 8. Section 58-70a-502 is amended to read:
303          58-70a-502. Unlawful conduct.
304          ["Unlawful conduct" includes engaging in practice as a licensed physician assistant
305     while not under the supervision of a supervising physician or substitute supervising physician.]
306          Reserved.
307          Section 9. Section 58-70a-503 is amended to read:
308          58-70a-503. Unprofessional conduct.
309          (1) "Unprofessional conduct" includes:
310          (a) violation of a patient confidence to any person who does not have a legal right and a
311     professional need to know the information concerning the patient;
312          (b) knowingly prescribing, selling, giving away, or directly or indirectly administering,
313     or offering to prescribe, sell, furnish, give away, or administer any prescription drug except for
314     a legitimate medical purpose upon a proper diagnosis indicating use of that drug in the amounts
315     prescribed or provided;
316          (c) prescribing prescription drugs for oneself or administering prescription drugs to
317     oneself, except those that have been legally prescribed for the physician assistant by a licensed
318     practitioner and that are used in accordance with the prescription order for the condition
319     diagnosed;
320          [(d) failure to maintain at the practice site a delegation of services agreement that
321     accurately reflects current practices;]
322          [(e) failure to make the delegation of services agreement available to the division for
323     review upon request;]
324          [(f)] (d) in a practice that has physician assistant ownership interests, failure to allow
325     [the supervising] a physician the independent final decision making authority on [patient]
326     treatment decisions[, as set forth in the delegation of services agreement or as defined by rule]
327     for the physician's patient;
328          [(g)] (e) violating the dispensing requirements of Chapter 17b, Part 8, Dispensing
329     Medical Practitioner and Dispensing Medical Practitioner Clinic Pharmacy, if applicable; [or]
330     and
331          [(h)] (f) falsely making an entry in, or altering, a medical record with the intent to
332     conceal:
333          (i) a wrongful or negligent act or omission of an individual licensed under this chapter
334     or an individual under the direction or control of an individual licensed under this chapter; or
335          (ii) conduct described in Subsections (1)(a) through [(g)] (e) or Subsection
336     58-1-501(1).
337          (2) (a) "Unprofessional conduct" does not include, in accordance with Title 26, Chapter
338     61a, Utah Medical Cannabis Act, when registered as a qualified medical provider, as that term
339     is defined in Section 26-61a-102, recommending the use of medical cannabis.
340          [(3)] (b) Notwithstanding Subsection (2)(a), the division, in consultation with the board
341     and in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, shall
342     define unprofessional conduct for a physician assistant described in Subsection (2)(a).
343          Section 10. Section 58-70a-507 is enacted to read:
344          58-70a-507. Volunteer health care services.
345          (1) A physician assistant may provide health care services as a volunteer for a
346     charitable organization or at a public or private event, including a religious event, youth camp,
347     community event, or health fair, if the physician assistant:
348          (a) receives no compensation for such services; and
349          (b) provides the health care services in a manner that is consistent with the physician
350     assistant's education, experience, and scope of practice.
351          (2) Notwithstanding Subsection 58-70a-501(8), a physician assistant who is providing
352     volunteer health services under this section may not issue a prescription to a patient for a
353     controlled substance.