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HOUSE AMENDED
PRIOR PRINTER'S NOS. 386, 871
PRINTER'S NO. 1084
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, BARTOLOTTA AND
BROOKS, MARCH 11, 2021
AS REPORTED FROM COMMITTEE ON PROFESSIONAL LICENSURE, HOUSE OF
REPRESENTATIVES, AS AMENDED, SEPTEMBER 20, 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. 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:
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"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]
nine members appointed by the Governor, [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
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
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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 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). , 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.
(5) THE BOARD MAY NOT REQUIRE, BY ORDER, REGULATION OR
ANY OTHER METHOD, COUNTERSIGNATURE REQUIREMENTS OF PATIENT
RECORDS COMPLETED BY A PHYSICIAN ASSISTANT THAT EXCEED THE
REQUIREMENTS SPECIFIED UNDER THIS SUBSECTION.
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(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
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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
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
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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 SHALL REVIEW 10% of all
written agreements on an annual basis SUBMITTED TO THE BOARD
AFTER THE EFFECTIVE DATE OF THIS PARAGRAPH . A written
agreement subject to an audit A REVIEW 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 REVIEW .
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 WRITTEN AGREEMENT
SUBMITTED TO THE BOARD DURING THE DECLARATION OF DISASTER
EMERGENCY ISSUED BY THE GOVERNOR ON MARCH 6, 2020, PUBLISHED
AT 50 PA.B. 1644 (MARCH 21, 2020), OR ANY RENEWAL OF THE
DECLARATION OF DISASTER EMERGENCY, SHALL BE DEEMED APPROVED.
THIS PARAGRAPH SHALL APPLY TO WRITTEN AGREEMENTS SUBMITTED TO
THE BOARD BEFORE THE EFFECTIVE DATE OF THIS PARAGRAPH.
(7) NO LATER THAN 120 DAYS FROM THE EFFECTIVE DATE OF
THIS PARAGRAPH, THE BOARD SHALL SUBMIT THE REVIEW PROCESS FOR
THE WRITTEN AGREEMENTS UNDER PARAGRAPH (6) TO THE LEGISLATIVE
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REFERENCE BUREAU FOR PUBLICATION IN THE PENNSYLVANIA
BULLETIN.
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 SIX 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
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. NOTHING IN THIS ACT SHALL BE CONSTRUED TO AUTHORIZE
AN EMPLOYER OR OTHER ENTITY TO REQUIRE A PHYSICIAN TO SUPERVISE
MORE PHYSICIAN ASSISTANTS WHEN THE PHYSICIAN, IN HIS OR HER
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CLINICAL JUDGMENT, DETERMINES THAT SUPERVISING MORE PHYSICIAN
ASSISTANTS WILL COMPROMISE PATIENT CARE OR OTHERWISE AFFECT THE
PHYSICIAN'S ABILITY TO PROPERLY SUPERVISE ANOTHER PHYSICIAN
ASSISTANT IN ACCORDANCE WITH THE REQUIREMENTS OF THIS ACT OR
REGULATIONS PROMULGATED BY THE BOARD.
* * *
Section 4. The State Board of Medicine shall promulgate
FINAL 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
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 6. This act shall take effect in 60 days
IMMEDIATELY.
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