Regular Session 2021-2022 Senate Bill 0398 P.N. 0871

PRIOR PRINTER'S NO. 386

PRINTER'S NO. 871

THE GENERAL ASSEMBLY OF PENNSYLVANIA

SENATE BILL

No.

398

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 December 20, 1985 (P.L.457, No.112),

entitled "An act relating to the right to practice medicine

and surgery and the right to practice medically related acts;

reestablishing the State Board of Medical Education and

Licensure as the State Board of Medicine and providing for

its composition, powers and duties; providing for the

issuance of licenses and certificates and the suspension and

revocation of licenses and certificates; provided penalties;

and making repeals," further providing for DEFINITIONS, FOR

State Board of Medicine and for physician assistants; AND

ABROGATING REGULATIONS.

The General Assembly of the Commonwealth of Pennsylvania

hereby enacts as follows:

Section 1. Section 3(a) and (b) of the act of December 20,

1985 (P.L.457, No.112), known as the Medical Practice Act of

1985, are amended to read:

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

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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:

Section 3. State Board of Medicine.

(a) Establishment.--The State Board of Medicine shall

consist of the commissioner or [his] THE COMMISSIONER'S

designee, the Secretary of Health or [his] THE SECRETARY OF

HEALTH'S designee, two members appointed by the Governor who

shall be persons representing the public at large and [seven]

eight NINE members appointed by the Governor, one of whom shall

be a physician assistant, [six] ONE OF WHOM SHALL BE A PHYSICIAN

ASSISTANT, SEVEN of whom shall be medical doctors with

unrestricted licenses to practice medicine and surgery in this

Commonwealth for five years immediately preceding their

appointment and one who shall be a nurse midwife, [physician

assistant, certified registered nurse practitioner,] respiratory

therapist, licensed athletic trainer or perfusionist licensed or

certified under the laws of this Commonwealth. 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.

(b) Terms of office.--The term of each professional and

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public member of the board shall be four years or until [his or

her] A successor has been appointed and qualified, but not

longer than six months beyond the four-year period. In the event

that any of said members shall die or resign or otherwise become

disqualified during [his or her] THE MEMBER'S term, a successor

shall be appointed in the same way and with the same

qualifications and shall hold office for the unexpired term. No

member shall be eligible for appointment to serve more than two

consecutive terms. The Governor shall assure that nurse

midwives, [physician assistants, certified registered nurse

practitioners,] perfusionists and respiratory therapists are

appointed to four-year terms on a rotating basis so that, of

every four appointments to a four-year term, one is a nurse

midwife, [one is a physician assistant, one is a certified

registered nurse practitioner] one is an athletic trainer, one

is a perfusionist and one is a respiratory therapist.

* * *

Section 2. Section 13(d), (d.1) and (e) of the act, amended

July 2, 2019 (P.L.413, No.68), are amended to read:

Section 13. Physician assistants.

* * *

(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.

(d.1) Patient record review.--

(1) The approved physician shall countersign 100% of the

patient records completed by the physician assistant within a

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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.] 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.

(e) Written agreement.--A physician assistant shall [not

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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

supervising physician will provide the physician assistant.

(4) Designates one [of the named physicians] physician

as having the primary responsibility for supervising [and

directing] the physician assistant.

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[(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

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.]

(5.1) 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 a request.

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 physician assistants for whom a

physician has responsibility or supervises pursuant to a written

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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 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.] provide medical

services in a manner as described in the agreement. A

supervising physician shall determine the number of physician

assistants supervised at any one time.

* * *

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

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

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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

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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

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

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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

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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

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

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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

FOR SUPERVISING [AND DIRECTING] THE PHYSICIAN ASSISTANT. IN

HEALTH CARE FACILITIES LICENSED UNDER THE HEALTH CARE FACILITIES

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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.

* * *

Section 3 4. The State Board of 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 §§

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.

Section 4 6. This act shall take effect in 60 days.

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