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          ▸     allows an associate physician to practice for a period of longer than six years;
13          ▸     repeals a restriction that an associate physician may only practice primary care
14     services; and
15          ▸     amends provisions relating to the collaborative practice arrangement for an
16     associate physician.
17     Money Appropriated in this Bill:
18          None
19     Other Special Clauses:
20          None
21     Utah Code Sections Affected:
22     AMENDS:
23          58-67-302.8, as last amended by Laws of Utah 2020, Chapters 124 and 339
24          58-67-303, as last amended by Laws of Utah 2020, Chapter 124
25          58-67-807, as last amended by Laws of Utah 2020, Chapter 124
26          58-68-302.5, as last amended by Laws of Utah 2020, Chapters 124 and 339
27          58-68-303, as last amended by Laws of Utah 2020, Chapter 124
28          58-68-807, as last amended by Laws of Utah 2020, Chapter 124
29     

30     Be it enacted by the Legislature of the state of Utah:
31          Section 1. Section 58-67-302.8 is amended to read:
32          58-67-302.8. Restricted licensing of an associate physician.
33          (1) An individual may apply for a restricted license as an associate physician if the
34     individual:
35          (a) meets the requirements described in Subsections 58-67-302(1)(a) through (c),
36     (1)(d)(i), and (1)(g) through (j);
37          (b) successfully completes Step 1 and Step 2 of the United States Medical Licensing
38     Examination or the equivalent steps of another board-approved medical licensing examination:
39          (i) within three years after the day on which the applicant graduates from a program
40     described in Subsection 58-67-302(1)(d)(i); and
41          (ii) within two years before applying for a restricted license as an associate physician;
42     and
43          (c) is not currently enrolled in and has not completed a residency program.
44          (2) Before a licensed associate physician may engage in the practice of medicine [as
45     described in Subsection (3)], the licensed associate physician shall:
46          (a) enter into a collaborative practice arrangement described in Section 58-67-807
47     within six months after the associate physician's initial licensure; and
48          (b) receive division approval of the collaborative practice arrangement.
49          [(3) An associate physician's scope of practice is limited to primary care services.]
50          Section 2. Section 58-67-303 is amended to read:
51          58-67-303. Term of license -- Expiration -- Renewal.
52          (1) (a) Except as provided in Section 58-67-302.7, the division shall issue each license
53     under this chapter in accordance with a two-year renewal cycle established by division rule.
54          (b) The division may by rule extend or shorten a renewal period by as much as one year
55     to stagger the renewal cycles the division administers.
56          (2) At the time of renewal, the licensee shall:
57          (a) view a suicide prevention video described in Section 58-1-601 and submit proof in
58     the form required by the division;
59          (b) show compliance with continuing education renewal requirements; and
60          (c) show compliance with the requirement for designation of a contact person and
61     alternate contact person for access to medical records and notice to patients as required by
62     Subsections 58-67-304(1)(b) and (c).
63          (3) Each license issued under this chapter expires on the expiration date shown on the
64     license unless renewed in accordance with Section 58-1-308.
65          [(4) An individual may not be licensed as an associate physician for more than a total
66     of six years.]
67          Section 3. Section 58-67-807 is amended to read:
68          58-67-807. Collaborative practice arrangement.
69          (1) (a) The division, in consultation with the board, shall make rules in accordance
70     with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, regarding the approval of a
71     collaborative practice arrangement.
72          (b) The division shall require a collaborative practice arrangement to:
73          (i) limit the associate physician to providing primary care services;
74          (ii) be consistent with the skill, training, and competence of the associate physician;
75          (iii) specify jointly agreed-upon protocols, or standing orders for the delivery of health
76     care services by the associate physician;
77          (iv) provide complete names, home and business addresses, zip codes, and telephone
78     numbers of the collaborating physician and the associate physician;
79          (v) list all other offices or locations besides those listed in Subsection (1)(b)(iv) where
80     the collaborating physician authorizes the associate physician to prescribe;
81          (vi) require at every office where the associate physician is authorized to prescribe in
82     collaboration with a physician a prominently displayed disclosure statement informing patients
83     that patients may be seen by an associate physician and have the right to see the collaborating
84     physician;
85          (vii) specify all specialty or board certifications of the collaborating physician and all
86     certifications of the associate physician;
87          (viii) specify the manner of collaboration between the collaborating physician and the
88     associate physician, including how the collaborating physician and the associate physician
89     shall:
90          (A) engage in collaborative practice consistent with each professional's skill, training,
91     education, and competence;
92          (B) maintain geographic proximity[, except as provided in Subsection (1)(d)]; and
93          (C) provide oversight of the associate physician during the absence, incapacity,
94     infirmity, or emergency of the collaborating physician;
95          (ix) describe the associate physician's controlled substance prescriptive authority in
96     collaboration with the collaborating physician, including:
97          (A) a list of the controlled substances the collaborating physician authorizes the
98     associate physician to prescribe; and
99          (B) documentation that the authorization to prescribe the controlled substances is
100     consistent with the education, knowledge, skill, and competence of the associate physician and
101     the collaborating physician;
102          (x) list all other written practice arrangements of the collaborating physician and the
103     associate physician; and
104          (xi) specify the duration of the written practice arrangement between the collaborating
105     physician and the associate physician[; and].
106          [(xii) describe the time and manner of the collaborating physician's review of the
107     associate physician's delivery of health care services, including provisions that the
108     collaborating physician, or another physician designated in the collaborative practice
109     arrangement, shall review every 14 days:]
110          [(A) a minimum of 10% of the charts documenting the associate physician's delivery of
111     health care services; and]
112          [(B) a minimum of 20% of the charts in which the associate physician prescribes a
113     controlled substance, which may be counted in the number of charts to be reviewed under
114     Subsection (1)(b)(xii)(A).]
115          (c) An associate physician and the collaborating physician may modify a collaborative
116     practice arrangement, but the changes to the collaborative practice arrangement are not binding
117     unless:
118          (i) the associate physician notifies the division within 10 days after the day on which
119     the changes are made; and
120          (ii) the division approves the changes.
121          [(d) If the collaborative practice arrangement provides for an associate physician to
122     practice in a medically underserved area:]
123          [(i) the collaborating physician shall document the completion of at least a two-month
124     period of time during which the associate physician shall practice with the collaborating
125     physician continuously present before practicing in a setting where the collaborating physician
126     is not continuously present; and]
127          [(ii) the collaborating physician shall document the completion of at least 120 hours in
128     a four-month period by the associate physician during which the associate physician shall
129     practice with the collaborating physician on-site before prescribing a controlled substance
130     when the collaborating physician is not on-site.]
131          (2) An associate physician:
132          (a) shall clearly identify himself or herself as an associate physician;
133          (b) is permitted to use the title "doctor" or "Dr."; and
134          (c) if authorized under a collaborative practice arrangement to prescribe Schedule III
135     through V controlled substances, shall register with the United States Drug Enforcement
136     Administration as part of the drug enforcement administration's mid-level practitioner registry.
137          (3) (a) A physician or surgeon licensed and in good standing under Section 58-67-302
138     may enter into a collaborative practice arrangement with an associate physician licensed under
139     Section 58-67-302.8.
140          (b) A physician or surgeon may not enter into a collaborative practice arrangement
141     with more than three full-time equivalent associate physicians.
142          (c) (i) No contract or other agreement shall:
143          (A) require a physician to act as a collaborating physician for an associate physician
144     against the physician's will;
145          (B) deny a collaborating physician the right to refuse to act as a collaborating
146     physician, without penalty, for a particular associate physician; or
147          (C) limit the collaborating physician's ultimate authority over any protocols or standing
148     orders or in the delegation of the physician's authority to any associate physician.
149          (ii) Subsection (3)(c)(i)(C) does not authorize a physician, in implementing protocols,
150     standing orders, or delegation, to violate a hospital's established applicable standards for safe
151     medical practice.
152          (d) A collaborating physician is responsible at all times for the oversight of the
153     activities of, and accepts responsibility for, the primary care services rendered by the associate
154     physician.
155          (4) The division shall makes rules, in consultation with the board, the deans of medical
156     schools in the state, and primary care residency program directors in the state, and in
157     accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, establishing
158     educational methods and programs that:
159          (a) an associate physician shall complete throughout the duration of the collaborative
160     practice arrangement;
161          (b) shall facilitate the advancement of the associate physician's medical knowledge and
162     capabilities; and
163          (c) may lead to credit toward a future residency program.
164          Section 4. Section 58-68-302.5 is amended to read:
165          58-68-302.5. Restricted licensing of an associate physician.
166          (1) An individual may apply for a restricted license as an associate physician if the
167     individual:
168          (a) meets the requirements described in Subsections 58-68-302(1)(a) through (c),
169     (1)(d)(i), and (1)(g) through (j);
170          (b) successfully completes Step 1 and Step 2 of the United States Medical Licensing
171     Examination or the equivalent steps of another board-approved medical licensing examination:
172          (i) within three years after the day on which the applicant graduates from a program
173     described in Subsection 58-68-302(1)(d)(i); and
174          (ii) within two years before applying for a restricted license as an associate physician;
175     and
176          (c) is not currently enrolled in and has not completed a residency program.
177          (2) Before a licensed associate physician may engage in the practice of medicine [as
178     described in Subsection (3)], the licensed associate physician shall:
179          (a) enter into a collaborative practice arrangement described in Section 58-68-807
180     within six months after the associate physician's initial licensure; and
181          (b) receive division approval of the collaborative practice arrangement.
182          [(3) An associate physician's scope of practice is limited to primary care service.]
183          Section 5. Section 58-68-303 is amended to read:
184          58-68-303. Term of license -- Expiration -- Renewal.
185          (1) (a) The division shall issue each license under this chapter in accordance with a
186     two-year renewal cycle established by division rule.
187          (b) The division may by rule extend or shorten a renewal period by as much as one year
188     to stagger the renewal cycles the division administers.
189          (2) At the time of renewal, the licensee shall:
190          (a) view a suicide prevention video described in Section 58-1-601 and submit proof in
191     the form required by the division;
192          (b) show compliance with continuing education renewal requirements; and
193          (c) show compliance with the requirement for designation of a contact person and
194     alternate contact person for access to medical records and notice to patients as required by
195     Subsections 58-68-304(1)(b) and (c).
196          (3) Each license issued under this chapter expires on the expiration date shown on the
197     license unless renewed in accordance with Section 58-1-308.
198          [(4) An individual may not be licensed as an associate physician for more than a total
199     of six years.]
200          Section 6. Section 58-68-807 is amended to read:
201          58-68-807. Collaborative practice arrangement.
202          (1) (a) The division, in consultation with the board, shall make rules in accordance
203     with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, regarding the approval of a
204     collaborative practice arrangement.
205          (b) The division shall require a collaborative practice arrangement to:
206          (i) limit the associate physician to providing primary care services;
207          (ii) be consistent with the skill, training, and competence of the associate physician;
208          (iii) specify jointly agreed-upon protocols, or standing orders for the delivery of health
209     care services by the associate physician;
210          (iv) provide complete names, home and business addresses, zip codes, and telephone
211     numbers of the collaborating physician and the associate physician;
212          (v) list all other offices or locations besides those listed in Subsection (1)(b)(iv) where
213     the collaborating physician authorizes the associate physician to prescribe;
214          (vi) require at every office where the associate physician is authorized to prescribe in
215     collaboration with a physician a prominently displayed disclosure statement informing patients
216     that patients may be seen by an associate physician and have the right to see the collaborating
217     physician;
218          (vii) specify all specialty or board certifications of the collaborating physician and all
219     certifications of the associate physician;
220          (viii) specify the manner of collaboration between the collaborating physician and the
221     associate physician, including how the collaborating physician and the associate physician
222     shall:
223          (A) engage in collaborative practice consistent with each professional's skill, training,
224     education, and competence;
225          (B) maintain geographic proximity[, except as provided in Subsection (1)(d)]; and
226          (C) provide oversight of the associate physician during the absence, incapacity,
227     infirmity, or emergency of the collaborating physician;
228          (ix) describe the associate physician's controlled substance prescriptive authority in
229     collaboration with the collaborating physician, including:
230          (A) a list of the controlled substances the collaborating physician authorizes the
231     associate physician to prescribe; and
232          (B) documentation that the authorization to prescribe the controlled substances is
233     consistent with the education, knowledge, skill, and competence of the associate physician and
234     the collaborating physician;
235          (x) list all other written practice arrangements of the collaborating physician and the
236     associate physician; and
237          (xi) specify the duration of the written practice arrangement between the collaborating
238     physician and the associate physician[; and].
239          [(xii) describe the time and manner of the collaborating physician's review of the
240     associate physician's delivery of health care services, including provisions that the
241     collaborating physician, or another physician designated in the collaborative practice
242     arrangement, shall review every 14 days:]
243          [(A) a minimum of 10% of the charts documenting the associate physician's delivery of
244     health care services; and]
245          [(B) a minimum of 20% of the charts in which the associate physician prescribes a
246     controlled substance, which may be counted in the number of charts to be reviewed under
247     Subsection (1)(b)(xii)(A).]
248          (c) An associate physician and the collaborating physician may modify a collaborative
249     practice arrangement, but the changes to the collaborative practice arrangement are not binding
250     unless:
251          (i) the associate physician notifies the division within 10 days after the day on which
252     the changes are made; and
253          (ii) the division approves the changes.
254          [(d) If the collaborative practice arrangement provides for an associate physician to
255     practice in a medically underserved area:]
256          [(i) the collaborating physician shall document the completion of at least a two-month
257     period of time during which the associate physician shall practice with the collaborating
258     physician continuously present before practicing in a setting where the collaborating physician
259     is not continuously present; and]
260          [(ii) the collaborating physician shall document the completion of at least 120 hours in
261     a four-month period by the associate physician during which the associate physician shall
262     practice with the collaborating physician on-site before prescribing a controlled substance
263     when the collaborating physician is not on-site.]
264          (2) An associate physician:
265          (a) shall clearly identify himself or herself as an associate physician;
266          (b) is permitted to use the title "doctor" or "Dr."; and
267          (c) if authorized under a collaborative practice arrangement to prescribe Schedule III
268     through V controlled substances, shall register with the United States Drug Enforcement
269     Administration as part of the drug enforcement administration's mid-level practitioner registry.
270          (3) (a) A physician or surgeon licensed and in good standing under Section 58-68-302
271     may enter into a collaborative practice arrangement with an associate physician licensed under
272     Section 58-68-302.5.
273          (b) A physician or surgeon may not enter into a collaborative practice arrangement
274     with more than three full-time equivalent associate physicians.
275          (c) (i) No contract or other agreement shall:
276          (A) require a physician to act as a collaborating physician for an associate physician
277     against the physician's will;
278          (B) deny a collaborating physician the right to refuse to act as a collaborating
279     physician, without penalty, for a particular associate physician; or
280          (C) limit the collaborating physician's ultimate authority over any protocols or standing
281     orders or in the delegation of the physician's authority to any associate physician.
282          (ii) Subsection (3)(c)(i)(C) does not authorize a physician, in implementing such
283     protocols, standing orders, or delegation, to violate a hospital's established applicable standards
284     for safe medical practice.
285          (d) A collaborating physician is responsible at all times for the oversight of the
286     activities of, and accepts responsibility for, the primary care services rendered by the associate
287     physician.
288          (4) The division shall makes rules, in consultation with the board, the deans of medical
289     schools in the state, and primary care residency program directors in the state, and in
290     accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, establishing
291     educational methods and programs that:
292          (a) an associate physician shall complete throughout the duration of the collaborative
293     practice arrangement;
294          (b) shall facilitate the advancement of the associate physician's medical knowledge and
295     capabilities; and
296          (c) may lead to credit toward a future residency program.