Senator Curtis S. Bramble proposes the following substitute bill:


1     
PHYSICIAN ASSISTANT MENTAL HEALTH PRACTICE

2     
AMENDMENTS

3     
2021 GENERAL SESSION

4     
STATE OF UTAH

5     
Chief Sponsor: Curtis S. Bramble

6     
House Sponsor: James A. Dunnigan

7     

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
18     care;
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:
23          None
24     Other Special Clauses:
25          This bill provides a coordination clause.

26     Utah Code Sections Affected:
27     AMENDS:
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
33     ENACTS:
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
39     

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
73     nursing;
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
78     therapy;
79          (f) a physician assistant specializing in mental health care under Section 58-70a-501.1;
80          [(f)] (g) a clinical social worker;
81          [(g)] (h) a certified social worker;
82          [(h)] (i) a marriage and family therapist;
83          [(i)] (j) an associate marriage and family therapist;
84          [(j)] (k) a clinical mental health counselor; or
85          [(k)] (l) an associate clinical mental health counselor.
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 [in order to:].
117          (b) Only an individual described in Subsection (1)(a) may:
118          [(a)] (i) engage in, or represent that the individual will engage in, the practice of mental

119     health therapy, clinical social work, certified social work, marriage and family therapy, or
120     clinical mental health counseling; or
121          [(b)] (ii) practice as, or represent that the individual is, a mental health therapist,
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
136     counselor.
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; [and]
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
166     provider;
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
183     disorders;
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
208     Utah;
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
221     58-70a-201.
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
228     include:
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
242     58-60-102.

243          [(4)] (5) "Practice as a physician assistant" means:
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.
253          [(5)] (7) "Substitute supervising physician" means an individual who meets the
254     requirements of a supervising physician under this chapter and acts as the supervising physician
255     in the absence of the supervising physician.
256          [(6)] (8) "Supervising physician" means an individual who:
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;
261     and
262          (c) is not an employee of the physician assistant whom the individual supervises.
263          [(7)] (9) "Supervision" means the supervising physician is available for consultation
264     with the physician assistant, either personally or by other means permitting direct verbal
265     communication between the physician and the physician assistant.
266          [(8)] (10) "Unlawful conduct" means the same as that term is [as] defined in Sections
267     58-1-501 and 58-70a-502.
268          [(9)] (11) "Unprofessional conduct" [is] means "unprofessional conduct":
269          (a) as defined in Sections 58-1-501 and 58-70a-503; and [as may be further defined by
270     rule.]
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
275     members:
276          (a) three licensed physicians[, at least two of whom are individuals who are supervising
277     or who have supervised a physician assistant], including at least one board certified
278     psychiatrist, who currently work or have previously worked collaboratively with a physician
279     assistant;
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;
295     or
296          (b) upon challenge for cause raised on the record by any party to the adjudicative
297     proceeding.
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
359     psychotherapy.
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
362     psychiatrist.
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 58-70a-501.2.
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
375     psychopharmacology.
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
394     psychiatry.
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 Section 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 Section 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."; and
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.";
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.