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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:
* * *
"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.
* * *
(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.
* * *
(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 ยงยง 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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