S0398B0386A01478 DMS:EJH 06/07/21 #90 A01478
AMENDMENTS TO SENATE BILL NO. 398
Sponsor: SENATOR PITTMAN
Printer's No. 386
Amend Bill, page 1, line 9, by inserting after "for"
definitions, for
Amend Bill, page 1, line 10, by inserting after "assistants"
; and abrogating regulations
Amend Bill, page 1, lines 13 through 15, by striking out all
of said lines and inserting
Section 1. The definition of "primary supervising physician"
in section 2 of the act of December 20, 1985 (P.L.457, No.112),
known as the Medical Practice Act of 1985, is amended to read:
Section 2. Definitions.
The following words and phrases when used in this act shall
have the meanings given to them in this section unless the
context clearly indicates otherwise:
* * *
"Primary supervising physician." A medical doctor who is
registered with the board and designated in a written agreement
with a physician assistant under section 13(e) as having primary
responsibility for [directing and personally] supervising the
physician assistant.
* * *
Section 2. Section 3(a) and (b) of the act are amended to
read:
Amend Bill, page 1, line 18, by inserting a bracket before
"his"
Amend Bill, page 1, line 18, by inserting after "his"
] the commissioner's
Amend Bill, page 1, line 19, by inserting a bracket before
"his"
Amend Bill, page 1, line 19, by inserting after "his"
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] the Secretary of Health's
Amend Bill, page 1, line 21, by striking out "eight" and
inserting
nine
Amend Bill, page 1, line 21; page 2, line 1; by striking out
"one of whom" in line 21 on page 1 and "shall be a physician
assistant," in line 1 on page 2
Amend Bill, page 2, line 1, by inserting a bracket before
"six"
Amend Bill, page 2, line 1, by inserting after "six"
] one of whom shall be a physician assistant, seven
Amend Bill, page 2, line 12, by inserting a bracket before
"his"
Amend Bill, page 2, line 13, by inserting after "her"
] a
Amend Bill, page 2, line 16, by inserting a bracket before
"his"
Amend Bill, page 2, line 16, by inserting after "her"
] the member's
Amend Bill, page 2, lines 29 and 30; pages 3 through 5, lines
1 through 30; page 6, lines 1 through 24; by striking out all of
said lines on said pages and inserting
Section 3. Section 13(c.1) introductory paragraph, (c.2)(1),
(d), (d.1), (e) and (g) of the act are amended to read:
Section 13. Physician assistants.
* * *
(c.1) Except as limited by subsection (c.2), and in addition
to existing authority, a physician assistant shall have
authority to do all of the following, provided that the
physician assistant is acting within the supervision [and
direction] of the supervising physician:
* * *
(c.2) Nothing in this section shall be construed to:
(1) Supersede the authority of the Department of Health
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and the Department of [Public Welfare] Human Services to
regulate the types of health care professionals who are
eligible for medical staff membership or clinical privileges.
* * *
(d) Supervision.--[A physician assistant shall not perform a
medical service without the supervision and personal direction
of an approved physician. The board shall promulgate regulations
which define the supervision and personal direction required by
the standards of acceptable medical practice embraced by the
medical doctor community in this Commonwealth.] The supervising
physician shall be responsible for the medical services that a
physician assistant renders. Supervision shall not require the
onsite presence or personal direction of the supervising
physician.
(d.1) Patient record review.--
[(1) The approved physician shall countersign 100% of
the patient records completed by the physician assistant
within a reasonable time, which shall not exceed ten days,
during each of the following time periods:
(i) The first 12 months of the physician assistant's
practice post graduation and after the physician
assistant has fulfilled the criteria for licensure set
forth in section 36(c).
(ii) The first 12 months of the physician
assistant's practice in a new specialty in which the
physician assistant is practicing.
(iii) The first six months of the physician
assistant's practice in the same specialty under the
supervision of the approved physician, unless the
physician assistant has multiple approved physicians and
practiced under the supervision of at least one of those
approved physicians for six months.
(2) In the case of a physician assistant who is not
subject to 100% review of the physician assistant's patient
records pursuant to paragraph (1), the approved physician
shall personally review on a regular basis a selected number
of the patient records completed by the physician assistant.
The approved physician shall select patient records for
review on the basis of written criteria established by the
approved physician and the physician assistant. The number of
patient records reviewed shall be sufficient to assure
adequate review of the physician assistant's scope of
practice.]
(3) The primary supervising physician shall determine
countersignature requirements of patient records completed by
the physician assistant in a written agreement, except as
provided for in paragraph (4).
(4) The primary supervising physician shall countersign
100% of patient records completed by the physician assistant
within a reasonable time, which shall not exceed ten days for
the first 12 months of the physician assistant's practice
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post graduation and after the physician assistant has
fulfilled the criteria for licensure set forth in section
36(c).
(e) Written agreement.--A physician assistant shall [not
provide a medical service without a written agreement with one
or more physicians] provide medical services according to a
written agreement which provides for all of the following:
(1) Identifies and is signed by [each physician the
physician assistant will be assisting] the primary
supervising physician.
(2) Describes the [manner in which the physician
assistant will be assisting each named physician. The written
agreement and description may be prepared and submitted by
the primary supervising physician, the physician assistant or
a delegate of the primary supervising physician and the
physician assistant. It shall not be a defense in any
administrative or civil action that the physician assistant
acted outside the scope of the board-approved description or
that the supervising physician utilized the physician
assistant outside the scope of the board-approved description
because the supervising physician or physician assistant
permitted another person to represent to the board that the
description had been approved by the supervising physician or
physician assistant] physician assistant's scope of practice.
(3) Describes the nature and degree of supervision [and
direction each named physician will provide the physician
assistant, including, but not limited to, the number and
frequency of the patient record reviews required by
subsection (d.1) and the criteria for selecting patient
records for review when 100% review is not required] the
primary supervising physician will provide the physician
assistant.
(4) [Designates one of the named physicians as having
the primary responsibility for supervising and directing the
physician assistant.] Is prepared and submitted by the
primary supervising physician, the physician assistant or a
delegate of the primary supervising physician and the
physician assistant. It shall not be a defense in any
administrative or civil action that the physician assistant
acted outside the scope of the board-filed description or
that the supervising physician utilized the physician
assistant outside the scope of the board-filed description
because the supervising physician or physician assistant
permitted another person to represent to the board that the
description had been approved by the supervising physician or
physician assistant.
[(5) Has been approved by the board as satisfying the
foregoing and as consistent with the restrictions contained
in or authorized by this section. Upon submission of the
application, board staff shall review the application only
for completeness and shall issue a letter to the supervising
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physician providing the temporary authorization for the
physician assistant to begin practice. If the application is
not complete, including, but not limited to, required
information or signatures not being provided or the fee not
being submitted, a temporary authorization for the physician
assistant to begin practicing shall not be issued. The
temporary authorization, when issued, shall provide a period
of 120 days during which the physician assistant may practice
under the terms set forth in the written agreement as
submitted to the board. Within 120 days the board shall
notify the supervising physician of the final approval or
disapproval of the application. If approved, a final approval
of the written agreement shall be issued to the supervising
physician. If there are discrepancies that have not been
corrected within the 120-day period, the temporary
authorization to practice shall expire.]
(6) Becomes effective upon submission by the primary
supervising physician, the physician assistant or a delegate
of the primary supervising physician and the physician
assistant to the board. The board may develop audit
procedures to ensure supervision and scope of practice
protections are maintained in accordance with this act. The
audit shall not include more than 10% of all written
agreements on an annual basis. A written agreement subject to
an audit shall remain in effect for two weeks after the board
notifies the primary supervising physician and the physician
assistant with remedies, if necessary, on the outcome of the
audit. The primary supervising physician, physician assistant
or delegate to the primary supervising physician and
physician assistant must submit a new written agreement which
shall be effective upon submission to the board.
A physician assistant shall not assist a physician in a manner
not described in the agreement or without the nature and degree
of supervision [and direction] described in the agreement. There
shall be no more than [four] six physician assistants for whom a
physician has responsibility or supervises pursuant to a written
agreement at any time. In health care facilities licensed under
the act of July 19, 1979 (P.L.130, No.48), known as the Health
Care Facilities Act, a physician assistant shall be under the
supervision [and direction] of a physician or physician group
pursuant to a written agreement, provided that a physician
supervises no more than [four] seven physician assistants at any
time. A physician may apply for a waiver to employ or supervise
more [than four] physician assistants at any time under this
section for good cause, as determined by the board.
* * *
(g) Supervision.--A physician assistant may be employed by a
health care facility licensed under the Health Care Facilities
Act under the supervision [and direction] of an approved
physician or group of such physicians, provided one of those
physicians is designated as having the primary responsibility
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for supervising [and directing] the physician assistant. In
health care facilities licensed under the Health Care Facilities
Act, the attending physician of record for a particular patient
shall act as the primary supervising physician for the physician
assistant while that patient is under the care of the attending
physician.
* * *
Amend Bill, page 6, line 25, by striking out "3" and
inserting
4
Amend Bill, page 6, by inserting between lines 27 and 28
Section 5. Any and all regulations at 49 Pa. Code ยงยง
18.142(5), 18.153(c), 18.158(b)(4) and 18.161(b) and other
provisions of 49 Pa. Code Ch. 18 are abrogated to the extent of
any inconsistency with this act.
Amend Bill, page 6, line 28, by striking out "4" and
inserting
6
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