1     
ASSOCIATE PHYSICIAN LICENSE AMENDMENTS

2     
2022 GENERAL SESSION

3     
STATE OF UTAH

4     
Chief Sponsor: Stewart E. Barlow

5     
Senate Sponsor: Michael S. Kennedy

6     

7     LONG TITLE
8     General Description:
9          This bill amends provisions relating to an associate physician license.
10     Highlighted Provisions:
11          This bill:
12          ▸     repeals a restriction that an associate physician may only practice primary care
13     services; and
14          ▸     amends provisions relating to the collaborative practice arrangement for an
15     associate physician.
16     Money Appropriated in this Bill:
17          None
18     Other Special Clauses:
19          None
20     Utah Code Sections Affected:
21     AMENDS:
22          58-67-302.8, as last amended by Laws of Utah 2020, Chapters 124 and 339
23          58-67-807, as last amended by Laws of Utah 2020, Chapter 124
24          58-68-302.5, as last amended by Laws of Utah 2020, Chapters 124 and 339
25          58-68-807, as last amended by Laws of Utah 2020, Chapter 124
26     

27     Be it enacted by the Legislature of the state of Utah:
28          Section 1. Section 58-67-302.8 is amended to read:
29          58-67-302.8. Restricted licensing of an associate physician.
30          (1) An individual may apply for a restricted license as an associate physician if the
31     individual:
32          (a) meets the requirements described in Subsections 58-67-302(1)(a) through (c),
33     (1)(d)(i), and (1)(g) through (j);
34          (b) successfully completes Step 1 and Step 2 of the United States Medical Licensing
35     Examination or the equivalent steps of another board-approved medical licensing examination:
36          (i) within three years after the day on which the applicant graduates from a program
37     described in Subsection 58-67-302(1)(d)(i); and
38          (ii) within two years before applying for a restricted license as an associate physician;
39     and
40          (c) is not currently enrolled in and has not completed a residency program.
41          (2) Before a licensed associate physician may engage in the practice of medicine [as
42     described in Subsection (3)], the licensed associate physician shall:
43          (a) enter into a collaborative practice arrangement described in Section 58-67-807
44     within six months after the associate physician's initial licensure; and
45          (b) receive division approval of the collaborative practice arrangement.
46          [(3) An associate physician's scope of practice is limited to primary care services.]
47          Section 2. Section 58-67-807 is amended to read:
48          58-67-807. Collaborative practice arrangement.
49          (1) (a) The division, in consultation with the board, shall make rules in accordance
50     with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, regarding the approval of a
51     collaborative practice arrangement.
52          (b) The division shall require a collaborative practice arrangement to:
53          (i) limit the associate physician to providing primary care services;
54          (ii) be consistent with the skill, training, and competence of the associate physician;
55          (iii) specify jointly agreed-upon protocols, or standing orders for the delivery of health
56     care services by the associate physician;
57          (iv) provide complete names, home and business addresses, zip codes, and telephone
58     numbers of the collaborating physician and the associate physician;
59          (v) list all other offices or locations besides those listed in Subsection (1)(b)(iv) where
60     the collaborating physician authorizes the associate physician to prescribe;
61          (vi) require at every office where the associate physician is authorized to prescribe in
62     collaboration with a physician a prominently displayed disclosure statement informing patients
63     that patients may be seen by an associate physician and have the right to see the collaborating
64     physician;
65          (vii) specify all specialty or board certifications of the collaborating physician and all
66     certifications of the associate physician;
67          (viii) specify the manner of collaboration between the collaborating physician and the
68     associate physician, including how the collaborating physician and the associate physician
69     shall:
70          (A) engage in collaborative practice consistent with each professional's skill, training,
71     education, and competence;
72          (B) maintain geographic proximity[, except as provided in Subsection (1)(d)]; and
73          (C) provide oversight of the associate physician during the absence, incapacity,
74     infirmity, or emergency of the collaborating physician;
75          (ix) describe the associate physician's controlled substance prescriptive authority in
76     collaboration with the collaborating physician, including:
77          (A) a list of the controlled substances the collaborating physician authorizes the
78     associate physician to prescribe; and
79          (B) documentation that the authorization to prescribe the controlled substances is
80     consistent with the education, knowledge, skill, and competence of the associate physician and
81     the collaborating physician;
82          (x) list all other written practice arrangements of the collaborating physician and the
83     associate physician; and
84          (xi) specify the duration of the written practice arrangement between the collaborating
85     physician and the associate physician[; and].
86          [(xii) describe the time and manner of the collaborating physician's review of the
87     associate physician's delivery of health care services, including provisions that the
88     collaborating physician, or another physician designated in the collaborative practice
89     arrangement, shall review every 14 days:]
90          [(A) a minimum of 10% of the charts documenting the associate physician's delivery of
91     health care services; and]
92          [(B) a minimum of 20% of the charts in which the associate physician prescribes a
93     controlled substance, which may be counted in the number of charts to be reviewed under
94     Subsection (1)(b)(xii)(A).]
95          (c) An associate physician and the collaborating physician may modify a collaborative
96     practice arrangement, but the changes to the collaborative practice arrangement are not binding
97     unless:
98          (i) the associate physician notifies the division within 10 days after the day on which
99     the changes are made; and
100          (ii) the division approves the changes.
101          [(d) If the collaborative practice arrangement provides for an associate physician to
102     practice in a medically underserved area:]
103          [(i) the collaborating physician shall document the completion of at least a two-month
104     period of time during which the associate physician shall practice with the collaborating
105     physician continuously present before practicing in a setting where the collaborating physician
106     is not continuously present; and]
107          [(ii) the collaborating physician shall document the completion of at least 120 hours in
108     a four-month period by the associate physician during which the associate physician shall
109     practice with the collaborating physician on-site before prescribing a controlled substance
110     when the collaborating physician is not on-site.]
111          (2) An associate physician:
112          (a) shall clearly identify himself or herself as an associate physician;
113          (b) is permitted to use the title "doctor" or "Dr."; and
114          (c) if authorized under a collaborative practice arrangement to prescribe Schedule III
115     through V controlled substances, shall register with the United States Drug Enforcement
116     Administration as part of the drug enforcement administration's mid-level practitioner registry.
117          (3) (a) A physician or surgeon licensed and in good standing under Section 58-67-302
118     may enter into a collaborative practice arrangement with an associate physician licensed under
119     Section 58-67-302.8.
120          (b) A physician or surgeon may not enter into a collaborative practice arrangement
121     with more than three full-time equivalent associate physicians.
122          (c) (i) No contract or other agreement shall:
123          (A) require a physician to act as a collaborating physician for an associate physician
124     against the physician's will;
125          (B) deny a collaborating physician the right to refuse to act as a collaborating
126     physician, without penalty, for a particular associate physician; or
127          (C) limit the collaborating physician's ultimate authority over any protocols or standing
128     orders or in the delegation of the physician's authority to any associate physician.
129          (ii) Subsection (3)(c)(i)(C) does not authorize a physician, in implementing protocols,
130     standing orders, or delegation, to violate a hospital's established applicable standards for safe
131     medical practice.
132          (d) A collaborating physician is responsible at all times for the oversight of the
133     activities of, and accepts responsibility for, the primary care services rendered by the associate
134     physician.
135          (4) The division shall makes rules, in consultation with the board, the deans of medical
136     schools in the state, and primary care residency program directors in the state, and in
137     accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, establishing
138     educational methods and programs that:
139          (a) an associate physician shall complete throughout the duration of the collaborative
140     practice arrangement;
141          (b) shall facilitate the advancement of the associate physician's medical knowledge and
142     capabilities; and
143          (c) may lead to credit toward a future residency program.
144          Section 3. Section 58-68-302.5 is amended to read:
145          58-68-302.5. Restricted licensing of an associate physician.
146          (1) An individual may apply for a restricted license as an associate physician if the
147     individual:
148          (a) meets the requirements described in Subsections 58-68-302(1)(a) through (c),
149     (1)(d)(i), and (1)(g) through (j);
150          (b) successfully completes Step 1 and Step 2 of the United States Medical Licensing
151     Examination or the equivalent steps of another board-approved medical licensing examination:
152          (i) within three years after the day on which the applicant graduates from a program
153     described in Subsection 58-68-302(1)(d)(i); and
154          (ii) within two years before applying for a restricted license as an associate physician;
155     and
156          (c) is not currently enrolled in and has not completed a residency program.
157          (2) Before a licensed associate physician may engage in the practice of medicine [as
158     described in Subsection (3)], the licensed associate physician shall:
159          (a) enter into a collaborative practice arrangement described in Section 58-68-807
160     within six months after the associate physician's initial licensure; and
161          (b) receive division approval of the collaborative practice arrangement.
162          [(3) An associate physician's scope of practice is limited to primary care service.]
163          Section 4. Section 58-68-807 is amended to read:
164          58-68-807. Collaborative practice arrangement.
165          (1) (a) The division, in consultation with the board, shall make rules in accordance
166     with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, regarding the approval of a
167     collaborative practice arrangement.
168          (b) The division shall require a collaborative practice arrangement to:
169          (i) limit the associate physician to providing primary care services;
170          (ii) be consistent with the skill, training, and competence of the associate physician;
171          (iii) specify jointly agreed-upon protocols, or standing orders for the delivery of health
172     care services by the associate physician;
173          (iv) provide complete names, home and business addresses, zip codes, and telephone
174     numbers of the collaborating physician and the associate physician;
175          (v) list all other offices or locations besides those listed in Subsection (1)(b)(iv) where
176     the collaborating physician authorizes the associate physician to prescribe;
177          (vi) require at every office where the associate physician is authorized to prescribe in
178     collaboration with a physician a prominently displayed disclosure statement informing patients
179     that patients may be seen by an associate physician and have the right to see the collaborating
180     physician;
181          (vii) specify all specialty or board certifications of the collaborating physician and all
182     certifications of the associate physician;
183          (viii) specify the manner of collaboration between the collaborating physician and the
184     associate physician, including how the collaborating physician and the associate physician
185     shall:
186          (A) engage in collaborative practice consistent with each professional's skill, training,
187     education, and competence;
188          (B) maintain geographic proximity[, except as provided in Subsection (1)(d)]; and
189          (C) provide oversight of the associate physician during the absence, incapacity,
190     infirmity, or emergency of the collaborating physician;
191          (ix) describe the associate physician's controlled substance prescriptive authority in
192     collaboration with the collaborating physician, including:
193          (A) a list of the controlled substances the collaborating physician authorizes the
194     associate physician to prescribe; and
195          (B) documentation that the authorization to prescribe the controlled substances is
196     consistent with the education, knowledge, skill, and competence of the associate physician and
197     the collaborating physician;
198          (x) list all other written practice arrangements of the collaborating physician and the
199     associate physician; and
200          (xi) specify the duration of the written practice arrangement between the collaborating
201     physician and the associate physician[; and].
202          [(xii) describe the time and manner of the collaborating physician's review of the
203     associate physician's delivery of health care services, including provisions that the
204     collaborating physician, or another physician designated in the collaborative practice
205     arrangement, shall review every 14 days:]
206          [(A) a minimum of 10% of the charts documenting the associate physician's delivery of
207     health care services; and]
208          [(B) a minimum of 20% of the charts in which the associate physician prescribes a
209     controlled substance, which may be counted in the number of charts to be reviewed under
210     Subsection (1)(b)(xii)(A).]
211          (c) An associate physician and the collaborating physician may modify a collaborative
212     practice arrangement, but the changes to the collaborative practice arrangement are not binding
213     unless:
214          (i) the associate physician notifies the division within 10 days after the day on which
215     the changes are made; and
216          (ii) the division approves the changes.
217          [(d) If the collaborative practice arrangement provides for an associate physician to
218     practice in a medically underserved area:]
219          [(i) the collaborating physician shall document the completion of at least a two-month
220     period of time during which the associate physician shall practice with the collaborating
221     physician continuously present before practicing in a setting where the collaborating physician
222     is not continuously present; and]
223          [(ii) the collaborating physician shall document the completion of at least 120 hours in
224     a four-month period by the associate physician during which the associate physician shall
225     practice with the collaborating physician on-site before prescribing a controlled substance
226     when the collaborating physician is not on-site.]
227          (2) An associate physician:
228          (a) shall clearly identify himself or herself as an associate physician;
229          (b) is permitted to use the title "doctor" or "Dr."; and
230          (c) if authorized under a collaborative practice arrangement to prescribe Schedule III
231     through V controlled substances, shall register with the United States Drug Enforcement
232     Administration as part of the drug enforcement administration's mid-level practitioner registry.
233          (3) (a) A physician or surgeon licensed and in good standing under Section 58-68-302
234     may enter into a collaborative practice arrangement with an associate physician licensed under
235     Section 58-68-302.5.
236          (b) A physician or surgeon may not enter into a collaborative practice arrangement
237     with more than three full-time equivalent associate physicians.
238          (c) (i) No contract or other agreement shall:
239          (A) require a physician to act as a collaborating physician for an associate physician
240     against the physician's will;
241          (B) deny a collaborating physician the right to refuse to act as a collaborating
242     physician, without penalty, for a particular associate physician; or
243          (C) limit the collaborating physician's ultimate authority over any protocols or standing
244     orders or in the delegation of the physician's authority to any associate physician.
245          (ii) Subsection (3)(c)(i)(C) does not authorize a physician, in implementing such
246     protocols, standing orders, or delegation, to violate a hospital's established applicable standards
247     for safe medical practice.
248          (d) A collaborating physician is responsible at all times for the oversight of the
249     activities of, and accepts responsibility for, the primary care services rendered by the associate
250     physician.
251          (4) The division shall makes rules, in consultation with the board, the deans of medical
252     schools in the state, and primary care residency program directors in the state, and in
253     accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, establishing
254     educational methods and programs that:
255          (a) an associate physician shall complete throughout the duration of the collaborative
256     practice arrangement;
257          (b) shall facilitate the advancement of the associate physician's medical knowledge and
258     capabilities; and
259          (c) may lead to credit toward a future residency program.