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        PRIOR PRINTER'S NOS. 2869, 3014               PRINTER'S NO. 3224

THE GENERAL ASSEMBLY OF PENNSYLVANIA


HOUSE BILL

No. 1999 Session of 2007


        INTRODUCED BY SEIP, J. EVANS, BENNINGTON, CALTAGIRONE, CASORIO,
           HARHAI, JOSEPHS, KULA, MAHONEY, McCALL, MURT, MUSTIO, MYERS,
           PETRARCA, SOLOBAY, WALKO, WATERS, YOUNGBLOOD, HARKINS,
           SONNEY, CIVERA, HORNAMAN, MACKERETH, MILLARD, KILLION, HELM,
           K. SMITH, PETRONE, FABRIZIO AND PASHINSKI, NOVEMBER 19, 2007

        AS AMENDED ON SECOND CONSIDERATION, HOUSE OF REPRESENTATIVES,
           FEBRUARY 11, 2008

                                     AN ACT

     1  Amending the act of December 20, 1985 (P.L.457, No.112),
     2     entitled "An act relating to the right to practice medicine
     3     and surgery and the right to practice medically related acts;
     4     reestablishing the State Board of Medical Education and
     5     Licensure as the State Board of Medicine and providing for
     6     its composition, powers and duties; providing for the
     7     issuance of licenses and certificates and the suspension and
     8     revocation of licenses and certificates; providing penalties;
     9     and making repeals," further providing for physician
    10     assistants and for respiratory care practitioners.

    11     The General Assembly of the Commonwealth of Pennsylvania
    12  hereby enacts as follows:
    13     Section 1.  Section 13 of the act of December 20, 1985
    14  (P.L.457, No.112), known as the Medical Practice Act of 1985, is
    15  amended by adding subsections to read:
    16  Section 13.  Physician assistants.
    17     * * *
    18     (c.1)  Except as limited by subsection (c.2), and in addition
    19  to existing authority, a physician assistant shall have
    20  authority to do all of the following, provided that the

     1  physician assistant is acting within the supervision and
     2  direction of the supervising physician:
     3     (1)  Order home health and hospice care.                       <--
     4     (2) (1)  Order durable medical equipment.                      <--
     5     (3) (2)  Issue oral orders to the extent permitted by a        <--
     6  health care facility's bylaws, rules, regulations or
     7  administrative policies and guidelines.
     8     (4) (3)  Order physical therapy and dietitian referrals.       <--
     9     (5) (4)  Order respiratory and occupational therapy            <--
    10  referrals.
    11     (6) (5)  Perform disability assessments for the program        <--
    12  providing Temporary Assistance to Needy Families (TANF).
    13     (7) (6)  Issue homebound schooling certifications.             <--
    14     (8) (7)  Perform and sign the initial assessment of methadone  <--
    15  treatment evaluations, provided that any order for methadone
    16  treatment shall be made only by a physician.
    17     (c.2)  Nothing in this section shall be construed to:
    18     (1)  Supersede the authority of the Department of Health and
    19  the Department of Public Welfare to regulate the types of health
    20  care professionals who are eligible for medical staff membership
    21  or clinical privileges.
    22     (2)  Restrict the authority of a health care facility to
    23  determine the scope of practice and supervision or other
    24  oversight requirements for health care professionals practicing
    25  within the facility.
    26     * * *
    27     Section 2.  Section 13.1(d) of the act, added July 2, 1993
    28  (P.L.424, No.60), is amended to read:
    29  Section 13.1.  Respiratory care practitioners.
    30     * * *
    20070H1999B3224                  - 2 -     

     1     (d)  Supervision and scope of practice.--A respiratory care
     2  practitioner certified by the board may implement direct
     3  respiratory care to an individual being treated by either a
     4  licensed medical doctor or a licensed doctor of osteopathic
     5  medicine, upon [physician] prescription or referral by a
     6  physician, certified registered nurse practitioner or physician
     7  assistant, or under medical direction and approval consistent
     8  with standing orders or protocols of an institution or health
     9  care facility. This care may constitute indirect services such
    10  as consultation or evaluation of an individual and also
    11  includes, but is not limited to, the following services:
    12         (1)  Administration of medical gases.
    13         (2)  Humidity and aerosol therapy.
    14         (3)  Administration of aerosolized medications.
    15         (4)  Intermittent positive pressure breathing.
    16         (5)  Incentive spirometry.
    17         (6)  Bronchopulmonary hygiene.
    18         (7)  Management and maintenance of natural airways.
    19         (8)  Maintenance and insertion of artificial airways.
    20         (9)  Cardiopulmonary rehabilitation.
    21         (10)  Management and maintenance of mechanical
    22     ventilation.
    23         (11)  Measurement of ventilatory flows, volumes and
    24     pressures.
    25         (12)  Analysis of ventilatory gases and blood gases.
    26     * * *
    27     Section 3.  Section 36 of the act, amended December 9, 2002
    28  (P.L.1344, No.160), is amended to read:
    29  Section 36.  Physician assistant license.
    30     (a)  General rule.--A physician assistant license empowers
    20070H1999B3224                  - 3 -     

     1  the holder to assist a medical doctor in the provision of
     2  medical care and services under the supervision and direction of
     3  that medical doctor as provided in this act.
     4     (b)  Requirements.--No physician assistant license may be
     5  issued to the applicant unless the requirements set forth by
     6  this act and such rules and regulations issued by the board are
     7  met, including requirements for the physician assistant training
     8  and educational programs which shall be formulated by the board
     9  in accordance with such national criteria as are established by
    10  national organizations or societies as the board may accept.
    11     (c)  Criteria.--The board shall grant physician assistant
    12  licenses to applicants who have fulfilled the following
    13  criteria:
    14         (1)  Satisfactory performance on the proficiency
    15     examination to the extent that a proficiency examination
    16     exists.
    17         (2)  Satisfactory completion of a certified program for
    18     the training and education of physician assistants.
    19         (3)  For candidates for initial licensure after January
    20     1, 2004, obtainment of a baccalaureate or higher degree from
    21     a college or university and completion of not less than 60
    22     clock hours of didactic instruction in pharmacology or other
    23     related courses as the board may approve by regulation.
    24     (d)  Biennial renewal.--A physician assistant license shall
    25  be subject to biennial renewal by the board. As part of biennial
    26  renewal, a physician assistant shall complete continuing medical
    27  education as required by the National Commission on
    28  Certification of Physician Assistants.
    29     (e)  Description of manner of assistance.--The application
    30  shall include a written request from the applicant's supervising
    20070H1999B3224                  - 4 -     

     1  medical doctor who shall file with the board a description of
     2  the manner in which the physician assistant will assist the
     3  supervising medical doctor, which description shall be subject
     4  to the approval of the board.
     5     (f)  Liability provision.--
     6         (1)  A physician assistant licensed in this Commonwealth
     7     shall maintain a level of professional liability insurance
     8     coverage as required for a nonparticipating health care
     9     provider under the act of March 20, 2002 (P.L.154, No.13),
    10     known as the Medical Care Availability and Reduction of Error
    11     (Mcare) Act, but shall not be eligible to participate in the
    12     Medical Care Availability and Reduction of Error (Mcare)
    13     Fund.
    14         (2)  The board shall accept from a licensed physician
    15     assistant as satisfactory evidence of insurance coverage any
    16     of the following:
    17             (i)  Self-insurance.
    18             (ii)  Personally purchased liability insurance.
    19             (iii)  Professional liability insurance coverage
    20         provided by the licensee's employer.
    21             (iv)  Similar insurance coverage acceptable to the
    22         board.
    23         (3)  A licensed physician assistant need not be
    24     separately insured if the licensee's employer is a health
    25     care provider as defined by the Medical Care Availability and
    26     Reduction of Error (Mcare) Act that maintains insurance as
    27     required by the Medical Care Availability and Reduction of
    28     Error (Mcare) Act or whose employer is not a health care
    29     provider as defined by the Medical Care Availability and
    30     Reduction of Error (Mcare) Act, but who maintains insurance
    20070H1999B3224                  - 5 -     

     1     at the level required of a nonparticipating health care
     2     provider under the Medical Care Availability and Reduction of
     3     Error (Mcare) Act.
     4     Section 4.  The State Board of Medicine, the Department of
     5  Public Welfare and the Department of Health shall promulgate
     6  regulations to implement the addition of section 13(c.1) and
     7  (c.2) of the act within 18 months of the effective date of this
     8  section.
     9     Section 5.  The following acts are repealed insofar as they
    10  are inconsistent with the addition of section 13(c.1) and (c.2)
    11  of the act:
    12         (1)  Section 9(a) of the act of October 10, 1975
    13     (P.L.383, No.110), known as the Physical Therapy Practice
    14     Act.
    15         (2)  Section 14 of the act of June 15, 1982 (P.L.502,
    16     No.140), known as the Occupational Therapy Practice Act.
    17     Section 6.  This act shall take effect in 60 days.









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