Regular Session 2019-2020 Senate Bill 0871 P.N. 2076

PRIOR PRINTER'S NO. 1222

PRINTER'S NO. 2076

THE GENERAL ASSEMBLY OF PENNSYLVANIA

SENATE BILL

No.

871

Session of

2019

INTRODUCED BY KILLION, BAKER, REGAN, COLLETT, FARNESE, YUDICHAK,

PITTMAN, YAW, BOSCOLA AND MARTIN, SEPTEMBER 27, 2019

SENATOR TOMLINSON, CONSUMER PROTECTION AND PROFESSIONAL

LICENSURE, AS AMENDED, OCTOBER 6, 2020

AN ACT

Amending the act of October 5, 1978 (P.L.1109, No.261), entitled

"An act requiring the licensing of practitioners of

osteopathic medicine and surgery; regulating their practice;

providing for certain funds and penalties for violations and

repeals," further providing for definitions, for State Board

of Osteopathic Medicine and, FOR PRACTICE OF OSTEOPATHIC

MEDICINE AND SURGERY WITHOUT LICENSE PROHIBITED AND for

licenses, exemptions, nonresident practitioners, graduate

students, biennial registration and continuing medical

education.

The General Assembly of the Commonwealth of Pennsylvania

hereby enacts as follows:

Section 1. The definition of "physician assistant" in

section 2 of the act of October 5, 1978 (P.L.1109, No.261),

known as the Osteopathic Medical Practice Act, is amended to

read:

SECTION 1. THE DEFINITIONS OF "PHYSICIAN ASSISTANT" AND

"PRIMARY SUPERVISING PHYSICIAN" IN SECTION 2 OF THE ACT OF

OCTOBER 5, 1978 (P.L.1109, NO.261), KNOWN AS THE OSTEOPATHIC

MEDICAL PRACTICE ACT, ADDED JULY 2, 2019 (P.L.415, NO.69), ARE

AMENDED TO READ:

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Section 2. Definitions.

The following words and phrases when used in this act shall

have, unless the context clearly indicates otherwise, the

meanings given to them in this section:

* * *

"Physician assistant." [A person licensed by the board to

assist a physician or group of physicians in the provision of

medical care and services and under the supervision and

direction of the physician or group of physicians.] An

individual who is licensed as a physician assistant by the

board.

"PRIMARY SUPERVISING PHYSICIAN." AN OSTEOPATHIC PHYSICIAN

[WHO IS REGISTERED WITH THE BOARD AND] DESIGNATED IN A WRITTEN

AGREEMENT WITH A PHYSICIAN ASSISTANT UNDER SECTION [10(G)]

10(G.4) AS HAVING PRIMARY RESPONSIBILITY FOR [DIRECTING AND

PERSONALLY] SUPERVISING THE PHYSICIAN ASSISTANT.

* * *

Section 2. Section 2.1(a) of the act is amended to read:

SECTION 2. SECTIONS 2.1(A) AND 3(B) OF THE ACT ARE AMENDED

TO READ:

Section 2.1. State Board of Osteopathic Medicine.

(a) The State Board of Osteopathic Medicine shall consist of

the Commissioner of Professional and Occupational Affairs or his

designee; the Secretary of Health or his designee; two members

appointed by the Governor who shall be persons representing the

public at large; one member appointed by the Governor who is a

physician assistant; one member appointed by the Governor who

shall be a respiratory therapist, a perfusionist[, a physician

assistant] or a licensed athletic trainer; and [six] SEVEN

members appointed by the Governor who shall be graduates of a

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legally incorporated and reputable college of osteopathic

medicine and shall have been licensed to practice osteopathic

medicine under the laws of this Commonwealth and shall have been

engaged in the practice of osteopathy in this Commonwealth for a

period of at least five years. All professional and public

members of the board shall be appointed by the Governor with the

advice and consent of a majority of the members elected to the

Senate. The Governor shall assure that respiratory therapists,

perfusionists[, physician assistants] and certified athletic

trainers are appointed to four-year terms on a rotating basis.

* * *

Section 3. Section 10(g) and (j.1) of the act, amended July

2, 2019 (P.L.415, No.69), are amended and the section is amended

by adding a subsection to read:

SECTION 3. PRACTICE OF OSTEOPATHIC MEDICINE AND SURGERY WITHOUT

LICENSE PROHIBITED.

* * *

(B) NOTHING IN THIS ACT SHALL BE CONSTRUED TO PROHIBIT

SERVICES AND ACTS RENDERED BY A QUALIFIED PHYSICIAN ASSISTANT,

TECHNICIAN OR OTHER ALLIED MEDICAL PERSON IF SUCH SERVICES AND

ACTS ARE RENDERED UNDER THE SUPERVISION, DIRECTION OR CONTROL OF

A LICENSED PHYSICIAN. IT SHALL BE UNLAWFUL FOR ANY PERSON TO

PRACTICE AS A PHYSICIAN ASSISTANT UNLESS LICENSED AND APPROVED

BY THE BOARD. IT SHALL ALSO BE UNLAWFUL FOR ANY PHYSICIAN

ASSISTANT TO RENDER MEDICAL CARE AND SERVICES EXCEPT UNDER THE

SUPERVISION [AND DIRECTION] OF THE PRIMARY SUPERVISING PHYSICIAN

IN ACCORDANCE WITH SECTION 10(G.4) AND (J.1). A PHYSICIAN

ASSISTANT MAY USE THE TITLE PHYSICIAN ASSISTANT OR AN

APPROPRIATE ABBREVIATION FOR THAT TITLE, SUCH AS "P.A.-C."

SECTION 3. SECTION 10(G), (G.2)(1) INTRODUCTORY PARAGRAPH,

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(J.1), (L) AND (M) OF THE ACT, AMENDED JULY 2, 2019 (P.L.415,

NO.69), ARE AMENDED AND THE SECTION IS AMENDED BY ADDING

SUBSECTIONS TO READ:

Section 10. Licenses; exemptions; nonresident practitioners;

graduate students; biennial registration and

continuing medical education.

* * *

(g) The PRIMARY supervising physician shall file, or cause

to be filed, with the board [an application to utilize a

physician assistant including a written agreement containing a

description of] a written agreement that identifies the manner

in which the physician assistant will assist the PRIMARY

supervising physician in his practice[,] and the method and

frequency of supervision.[, including, but not limited to, the

number and frequency of the patient record reviews required by

subsection (j.1) and the criteria for selecting patient records

for review when 100% review is not required, and the geographic

location of the physician assistant. 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. Upon submission of the

application, board staff shall review the application only for

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completeness and shall issue a letter to the supervising

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. There shall be no more

than four 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

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 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. In cases where a

group of physicians will supervise a physician assistant, the

names of all supervisory physicians shall be included on the

application.] The PRIMARY supervising physician shall determine

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the number of MAY SUPERVISE SEVEN physician assistants

supervised at any one time. The PRIMARY supervising physician

shall be responsible for the medical services that a physician

assistant renders. Supervision shall not require the onsite

presence or the personal direction of the PRIMARY supervising

physician.

* * *

(G.2) (1) EXCEPT AS LIMITED BY PARAGRAPH (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 PRIMARY SUPERVISING PHYSICIAN:

* * *

(g.4) A physician assistant shall provide medical services

according to a written agreement which provides for all of the

following:

(1) Identifies and is signed by the primary supervising

physician.

(1.1) IDENTIFIES AND IS SIGNED BY AN ALTERNATIVE

SUPERVISING PHYSICIAN IN ORDER TO MAINTAIN THE CONTINUITY OF

CARE IF THE PRIMARY SUPERVISING PHYSICIAN CANNOT FULFILL THE

RESPONSIBILITIES. IF THE ALTERNATIVE SUPERVISING PHYSICIAN

BECOMES THE PRIMARY SUPERVISING PHYSICIAN, THE PHYSICIAN,

PHYSICIAN ASSISTANT OR THEIR DESIGNEE HAS 30 DAYS TO MAKE THE

BOARD AWARE OF THE CHANGE.

(2) Describes the physician assistant's scope of

practice.

(3) Describes the nature and degree of supervision the

PRIMARY supervising physician will provide the physician

assistant.

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(4) Designates one physician as having the primary

responsibility for supervising the physician assistant.

(5) Is maintained by the supervising physician at the

practice or health care facility and available to the board

upon request. The written agreement shall be supplied to the

board within 30 days of the request. A physician assistant

shall provide medical services in a manner as described in

the agreement.

(4) IS FILED WITH THE BOARD BY THE PRIMARY SUPERVISING

PHYSICIAN, THE PHYSICIAN ASSISTANT OR A DELEGATE OF THE

PRIMARY SUPERVISING PHYSICIAN AND PHYSICIAN ASSISTANT AND A

COPY MAINTAINED BY THE PRIMARY SUPERVISING PHYSICIAN AT THE

PRACTICE OR HEALTH CARE FACILITY 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 PRACTICE OR THAT THE PRIMARY SUPERVISING PHYSICIAN

UTILIZED THE PHYSICIAN ASSISTANT OUTSIDE THE SCOPE OF

PRACTICE BECAUSE THE PRIMARY SUPERVISING PHYSICIAN OR

PHYSICIAN ASSISTANT PERMITTED ANOTHER PERSON TO REPRESENT TO

THE BOARD THAT THE DESCRIPTION HAD BEEN APPROVED BY THE

PRIMARY SUPERVISING PHYSICIAN OR PHYSICIAN ASSISTANT. A

WRITTEN AGREEMENT GOES INTO EFFECT ONCE IT IS FILED WITH THE

BOARD.

* * *

[(j.1) (1) The [approved] PRIMARY SUPERVISING 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

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[practice post graduation and after the physician

assistant has fulfilled the criteria for licensure set

forth in subsection (f).] EMPLOYMENT OUTLINED UNDER THE

WRITTEN AGREEMENT.

(ii) The first [12] SIX 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.]

* * *

(J.2) THE FOLLOWING APPLY:

(1) THE PRIMARY SUPERVISING PHYSICIAN SHALL BE

RESPONSIBLE FOR THE MEDICAL SERVICES THAT A PHYSICIAN

ASSISTANT RENDERS.

(2) A PHYSICIAN ASSISTANT SUBJECT TO SUBSECTION (J.1)

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SHALL NOT BE ELIGIBLE TO PERFORM A MEDICAL SERVICE WITHOUT

THE SUPERVISION OF AN APPROVED PHYSICIAN.

(3) THE PRIMARY SUPERVISING PHYSICIAN MAY REQUIRE

PERSONAL REVIEW OF A SELECTED NUMBER OF PATIENT RECORDS

COMPLETED BY THE PHYSICIAN ASSISTANT IN ORDER TO MAINTAIN THE

SUPERVISORY ROLE OUTLINED IN THE WRITTEN AGREEMENT.

* * *

(L) NOTHING IN THIS ACT SHALL BE CONSTRUED TO PROHIBIT THE

EMPLOYMENT OF PHYSICIAN ASSISTANTS BY A HEALTH CARE FACILITY

WHERE SUCH PHYSICIAN ASSISTANTS FUNCTION UNDER THE SUPERVISION

AND DIRECTION OF A PRIMARY SUPERVISING PHYSICIAN OR GROUP OF

PHYSICIANS.

(M) THE PHYSICIAN ASSISTANT BEING LICENSED IN THIS ACT AND

FUNCTIONING UNDER THE SUPERVISION OF THE PRIMARY SUPERVISING

PHYSICIAN DEFINES HIS/HER STATUS AS AN EMPLOYEE AND SUBJECT TO

THE NORMAL EMPLOYER/EMPLOYEE REIMBURSEMENT PROCEDURES.

* * *

Section 4. The State Board of OSTEOPATHIC Medicine shall

promulgate rules and regulations necessary to carry out this act

within 180 days of the effective date of this section.

Section 5. This act shall take effect in 60 days.

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