Regular Session 2021-2022 Senate Bill 0397 P.N. 0870

PRIOR PRINTER'S NO. 385

PRINTER'S NO. 870

THE GENERAL ASSEMBLY OF PENNSYLVANIA

SENATE BILL

No.

397

Session of

2021

INTRODUCED BY PITTMAN, SCAVELLO, COLLETT, YUDICHAK, MENSCH, YAW,

BAKER, HUTCHINSON, STEFANO, REGAN, BOSCOLA AND BARTOLOTTA,

MARCH 11, 2021

SENATOR TOMLINSON, CONSUMER PROTECTION AND PROFESSIONAL

LICENSURE, AS AMENDED, JUNE 8, 2021

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, FOR PRACTICE OF OSTEOPATHIC MEDICINE

AND SURGERY WITHOUT LICENSE PROHIBITED and for licenses,

exemptions, nonresident practitioners, graduate students,

biennial registration and continuing medical education; AND

ABROGATING REGULATIONS.

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, ARE AMENDED TO READ:

Section 2. Definitions.

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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:

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"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) 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] A designee; the Secretary of Health or [his] A 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 legally incorporated and reputable

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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. 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 SUPERVISING PHYSICIAN. 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) 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. SECTION 10(G), (G.2), (J) (J.1), (K) AND (L) OF

THE ACT ARE AMENDED AND THE SECTION IS AMENDED BY ADDING A

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SUBSECTION TO READ:

Section 10. Licenses; exemptions; nonresident practitioners;

graduate students; biennial registration and

continuing medical education.

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(g) The supervising physician shall file, or cause to be

(G) (1) 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 [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.] PRIMARY SUPERVISING PHYSICIAN, ACCORDING TO

SUBSECTION (G.4). 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] BOARD-FILED description or that the

supervising physician utilized the physician assistant

outside the scope of the [board-approved] 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

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physician or physician assistant. [Upon submission of the

application, board staff shall review the application only

for 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.]

(2) THE WRITTEN AGREEMENT 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 CHAPTER. 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

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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.

(3) 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 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. 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 supervising

physician shall determine the number of physician assistants

supervised at any one time. The 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 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

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PHYSICIAN ASSISTANT IS ACTING WITHIN THE SUPERVISION [AND

DIRECTION] OF THE SUPERVISING PHYSICIAN:

(I) ORDER DURABLE MEDICAL EQUIPMENT.

(II) ISSUE ORAL ORDERS TO THE EXTENT PERMITTED BY A

HEALTH CARE FACILITY'S BYLAWS, RULES, REGULATIONS OR

ADMINISTRATIVE POLICIES AND GUIDELINES.

(III) ORDER PHYSICAL THERAPY AND DIETITIAN

REFERRALS.

(IV) ORDER RESPIRATORY AND OCCUPATIONAL THERAPY

REFERRALS.

(V) PERFORM DISABILITY ASSESSMENTS FOR THE PROGRAM

PROVIDING TEMPORARY ASSISTANCE TO NEEDY FAMILIES (TANF).

(VI) ISSUE HOMEBOUND SCHOOLING CERTIFICATIONS.

(VII) PERFORM AND SIGN THE INITIAL ASSESSMENT OF

METHADONE TREATMENT EVALUATIONS IN ACCORDANCE WITH

FEDERAL AND STATE LAW, PROVIDED THAT ANY ORDER FOR

METHADONE TREATMENT SHALL BE MADE ONLY BY A PHYSICIAN.

(2) NOTHING IN THIS SUBSECTION SHALL BE CONSTRUED TO:

(I) SUPERSEDE THE AUTHORITY OF THE DEPARTMENT OF

HEALTH 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.

(II) RESTRICT THE AUTHORITY OF A HEALTH CARE

FACILITY TO DETERMINE THE SCOPE OF PRACTICE AND

SUPERVISION OR OTHER OVERSIGHT REQUIREMENTS FOR HEALTH

CARE PROFESSIONALS PRACTICING WITHIN THE FACILITY.

* * *

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

according to a written agreement which provides for all of the

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following:

(1) Identifies and is signed by the primary supervising

physician.

(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.

(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.

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(J) NOTHING IN THIS ACT SHALL BE CONSTRUED TO PERMIT A

LICENSED PHYSICIAN ASSISTANT TO PRACTICE OSTEOPATHIC MEDICINE

WITHOUT THE SUPERVISION [AND DIRECTION] OF A LICENSED PHYSICIAN

APPROVED BY THE APPROPRIATE BOARD, BUT SUCH SUPERVISION [AND

DIRECTION] SHALL NOT BE CONSTRUED TO [NECESSARILY] REQUIRE THE

PERSONAL PRESENCE OF THE SUPERVISING PHYSICIAN AT THE PLACE

WHERE THE SERVICES ARE RENDERED.

[(j.1) [(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

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assistant has fulfilled the criteria for licensure set

forth in subsection (f).

(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 APPROVED PHYSICIAN SHALL COUNTERSIGN 100% OF THE

PATIENT RECORDS COMPLETED BY THE PHYSICIAN ASSISTANT WITHIN A

REASONABLE TIME, WHICH SHALL NOT EXCEED 10 DAYS, FOR THE

FIRST 12 MONTHS OF THE PHYSICIAN ASSISTANT'S PRACTICE POST

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GRADUATION AND AFTER THE PHYSICIAN ASSISTANT HAS FULFILLED

THE CRITERIA FOR LICENSURE SPECIFIED IN SUBSECTION (F).

(K) THIS ACT SHALL NOT BE CONSTRUED TO PROHIBIT THE

PERFORMANCE BY THE PHYSICIAN ASSISTANT OF ANY SERVICE WITHIN

[HIS] THE PHYSICIAN ASSISTANT'S SKILLS, WHICH IS DELEGATED BY

THE SUPERVISING PHYSICIAN, AND WHICH FORMS A USUAL COMPONENT OF

THAT PHYSICIAN'S SCOPE OF PRACTICE.

(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 PHYSICIAN OR GROUP OF PHYSICIANS.

* * *

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. ANY AND ALL REGULATIONS AT 49 PA. CODE §§ 25.142,

25.162, 25.178 AND 25.181 ARE ABROGATED TO THE EXTENT OF ANY

INCONSISTENCY WITH THIS ACT.

Section 5 6. This act shall take effect in 60 days.

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