Regular Session 2019-2020 Senate Bill 0391 P.N. 2009

PRIOR PRINTER'S NO. 374

PRINTER'S NO. 2009

THE GENERAL ASSEMBLY OF PENNSYLVANIA

SENATE BILL

No.

391

Session of

2019

INTRODUCED BY GORDNER, SCARNATI, FOLMER, BAKER, HUTCHINSON,

YUDICHAK, HAYWOOD AND PITTMAN, MARCH 5, 2019

SENATOR TOMLINSON, CONSUMER PROTECTION AND PROFESSIONAL

LICENSURE, AS AMENDED, SEPTEMBER 22, 2020

AN ACT

Amending the act of June 6, 1980 (P.L.197, No.57), entitled "An

act regulating the licensure and practice of optometry,

making repeals and providing penalties," further providing

for definitions, for approval of drugs, for exemptions and

exceptions and for violations and penalties; and providing

for insurance billing codes.

AMENDING THE ACT OF JUNE 6, 1980 (P.L.197, NO.57), ENTITLED "AN

ACT REGULATING THE LICENSURE AND PRACTICE OF OPTOMETRY,

MAKING REPEALS AND PROVIDING PENALTIES," FURTHER PROVIDING

FOR DEFINITIONS, FOR APPROVAL OF DRUGS, FOR EXEMPTIONS AND

EXCEPTIONS AND FOR VIOLATIONS AND PENALTIES.

The General Assembly of the Commonwealth of Pennsylvania

hereby enacts as follows:

Section 1. The definitions of "examination and diagnosis,"

"optometrist" and "practice of optometry" in section 2 of the

act of June 6, 1980 (P.L.197, No.57), known as the Optometric

Practice and Licensure Act, are amended to read:

Section 2. Definitions.

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:

* * *

<--

"Examination and diagnosis." Any examination or diagnostic

means or method compatible with optometric education and

professional competence. The term shall encompass the use of

pharmaceutical agents approved by the Food and Drug

Administration and published in the Code of Federal Regulations

for diagnostic purposes [classified as], including miotics,

mydriatics, cycloplegics, topical anesthetics and dyes when

applied topically to the eye, [which pharmaceutical agents shall

be approved by the Secretary of Health as provided in section

4.3 and,] subject to the rules and regulations of the board,

provided however that with respect to optometrists licensed

before March 1, 1974, only such optometrists who have

satisfactorily completed a course in pharmacology as it applies

to optometry, with particular emphasis on the [topical]

application of diagnostic pharmaceutical agents to the eye,

approved by the board shall be permitted to use diagnostic

pharmaceutical agents [topically] in the practice of optometry.

* * *

"Optometrist." Any person who, following formal and

recognized training in the art and science of optometry has

received a doctor of optometry degree from an accredited

institution and is qualified to seek or has acquired a license

to practice the profession of optometry. An optometrist shall be

identified either by "Doctor of Optometry," ["O.D.," or "Dr."

followed by "Optometrist."] "O.D." or "Doctor."

"Practice of optometry."

(1) The use of any and all means or methods for the

examination, diagnosis, prevention and treatment of all

conditions [of] affecting the human visual system [and shall

include the examination for, and adapting and fitting of, any

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and all kinds and types of lenses including contact lenses.],

including all conditions of the human eye and adnexa

applicable to this act. The term shall include:

(i) The examination for, and adapting and fitting

of, any and all kinds and types of lenses, including

contact lenses.

(ii) The administration and prescription of all

legend and nonlegend drugs, by any means, methods or

delivery systems, approved by the board in section 4.3

for the treatment of diseases and conditions affecting

the eye and adnexa, including codeine and hydrocodone

combinations which were reclassified from Schedule III to

Schedule II prior to the effective date of this

subparagraph. The prescription of Schedule II controlled

substances containing codeine and hydrocodone

combinations may not exceed a 72-hour supply.

(iii) The removal of superficial foreign bodies.

(iv) The draining of superficial cysts.

(v) Epinephrine auto-injectors for anaphylaxis.

(vi) The ordering and interpretation of angiography

via noninvasive imaging, including, but not limited to,

light wave imaging and other imaging tests.

(vii) The treatment of glaucoma.

[(2) The administration and prescription of legend and

nonlegend drugs as approved by the Secretary of Health as

provided in section 4.3 for treatment of the eye, the

eyelids, the lacrimal system and the conjunctiva and the

removal of superficial foreign bodies from the ocular surface

and adnexa so long as treatment of diseases or conditions of

the visual system, other than glaucoma, as authorized under

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this paragraph shall not continue beyond six weeks from the

initiation of treatment unless the prescribing optometrist

documents consultation with a licensed physician. As used in

this paragraph, the initiation of treatment may, but need

not, include the prescription or administration of

pharmaceutical agents for therapeutic purposes.

(3) The term shall not include:

(i) surgery, including, but not limited to, laser

surgery; the use of lasers for therapeutic purposes; and

the use of injections in the treatment of ocular disease;

(ii) the use of Schedule I and Schedule II

controlled substances;

(iii) treatment of systemic disease; and

(iv) the treatment of glaucoma, except that

optometrists may use all topical pharmaceutical agents in

the treatment of primary open angle glaucoma, exfoliation

glaucoma and pigmentary glaucoma.]

(4) The term shall not include:

(i) Surgery with a scalpel or scissors, refractive

or therapeutic surgery with a laser and surgery with a

CryoProbe.

(ii) Injection into the globe.

(iii) The use of Schedule I and Schedule II

controlled substances, except for the use of codeine and

hydrocodone combinations which were reclassified from

Schedule III to Schedule II prior to the effective date

of this subparagraph and any drugs approved by the board

in section 4.3 for the treatment of ocular disease.

* * *

Section 2. Sections 4.3 and 6(b) of the act are amended to

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read:

Section 4.3. Approval of drugs.

Drugs shall be approved as follows:

(1) All drugs currently approved by the Secretary of

Health and in use in the practice of optometry on the

effective date of this section shall be deemed approved under

this section.

[(2) Within 90 days of the effective date of this

section, the board shall submit a list of drugs authorized

under this act to the Secretary of Health, who, in

consultation with the Physician General, shall approve or

disapprove for good cause each drug. Upon failure of the

Secretary of Health to act within 90 days of receipt of the

list of drugs, the drugs shall be deemed approved for use

under this act.

(3) The State Board of Optometry shall provide the

Secretary of Health with lists of additional drugs for use

under this act after such drugs are approved by the Food and

Drug Administration, as published in the Code of Federal

Regulations. The Secretary of Health, in consultation with

the Physician General, shall approve or disapprove for good

cause any such drug within 90 days of the receipt of the

list. Upon failure of the Secretary of Health to act within

90 days, the drugs shall be deemed approved for use under

this act.]

(4) On and after the effective date of this paragraph,

the board may approve drugs for use in the practice of

optometry after the drugs are approved by the Food and Drug

Administration, as published in the Code of Federal

Regulations.

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Section 6. Exemptions and exceptions.

* * *

(b) The board shall permit externs, who are [fourth year]

optometric students, to perform procedures and tests for the

sole purpose of instruction and experience under the direct

supervision and control of an optometrist licensed in this

Commonwealth. Nothing contained in this act shall be construed

to entitle an extern to practice optometry.

* * *

Section 3. Section 8(a) of the act is amended by adding a

paragraph to read:

Section 8. Violations and penalties.

(a) * * *

(4) It is unlawful for an optometrist to advertise a

service prohibited under this act. A person convicted of

violating this paragraph commits a summary offense and shall,

for a first offense, be subject to a fine of not more than

$500. For a second or subsequent violation, the board may

impose a suspension of the person's license for up to 30

days, in addition to the fine.

* * *

Section 4. The act is amended by adding a section to read:

Section 10.1. Insurance billing codes.

An insurance billing code may not be used to define or

interpret a procedure performed by an optometrist as surgery.

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

SECTION 1. THE DEFINITIONS OF "EXAMINATION AND DIAGNOSIS"

AND "PRACTICE OF OPTOMETRY" IN SECTION 2 OF THE ACT OF JUNE 6,

1980 (P.L.197, NO.57), KNOWN AS THE OPTOMETRIC PRACTICE AND

LICENSURE ACT, ARE AMENDED TO READ:

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<--

SECTION 2. DEFINITIONS.

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:

* * *

"EXAMINATION AND DIAGNOSIS." ANY EXAMINATION OR DIAGNOSTIC

MEANS OR METHOD COMPATIBLE WITH OPTOMETRIC EDUCATION AND

PROFESSIONAL COMPETENCE. THE TERM SHALL ENCOMPASS THE USE OF

TOPICAL AND ORAL PHARMACEUTICAL AGENTS APPROVED BY THE BOARD AS

PROVIDED IN SECTION 4.3 FOR DIAGNOSTIC PURPOSES [CLASSIFIED AS],

INCLUDING MIOTICS, MYDRIATICS, CYCLOPLEGICS, TOPICAL ANESTHETICS

AND DYES WHEN APPLIED TOPICALLY TO THE EYE, [WHICH

PHARMACEUTICAL AGENTS SHALL BE APPROVED BY THE SECRETARY OF

HEALTH AS PROVIDED IN SECTION 4.3 AND,] SUBJECT TO THE RULES AND

REGULATIONS OF THE BOARD, PROVIDED HOWEVER THAT WITH RESPECT TO

OPTOMETRISTS LICENSED BEFORE MARCH 1, 1974, ONLY SUCH

OPTOMETRISTS WHO HAVE SATISFACTORILY COMPLETED A COURSE IN

PHARMACOLOGY AS IT APPLIES TO OPTOMETRY, WITH PARTICULAR

EMPHASIS ON THE TOPICAL APPLICATION OF DIAGNOSTIC PHARMACEUTICAL

AGENTS TO THE EYE, APPROVED BY THE BOARD SHALL BE PERMITTED TO

USE DIAGNOSTIC PHARMACEUTICAL AGENTS TOPICALLY IN THE PRACTICE

OF OPTOMETRY.

* * *

"PRACTICE OF OPTOMETRY."

(1) THE USE OF ANY AND ALL MEANS OR METHODS FOR THE

EXAMINATION, DIAGNOSIS AND TREATMENT OF ALL CONDITIONS OF THE

HUMAN VISUAL SYSTEM [AND SHALL INCLUDE THE EXAMINATION FOR,

AND ADAPTING AND FITTING OF, ANY AND ALL KINDS AND TYPES OF

LENSES INCLUDING CONTACT LENSES]. THE TERM SHALL INCLUDE:

(I) THE EXAMINATION FOR, AND ADAPTING AND FITTING

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OF, ANY AND ALL KINDS AND TYPES OF LENSES, INCLUDING

CONTACT LENSES.

(II) THE ADMINISTRATION AND PRESCRIPTION OF ALL

LEGEND AND NONLEGEND DRUGS , EITHER BY TOPICAL OR ORAL

ROUTES OF ADMINISTRATION, APPROVED BY THE BOARD IN

SECTION 4.3 FOR THE TREATMENT OF THE EYE, THE EYELIDS,

THE LACRIMAL SYSTEM AND THE CONJUNCTIVA, INCLUDING

CODEINE AND HYDROCODONE COMBINATIONS , SO LONG AS THE

TREATMENT OF DISEASES OR CONDITIONS OF THE VISUAL SYSTEM,

OTHER THAN GLAUCOMA, DRY EYES OR ALLERGIES, AS AUTHORIZED

UNDER THIS PARAGRAPH SHALL NOT CONTINUE BEYOND SIX WEEKS

FROM THE INITIATION OF TREATMENT UNLESS THE PRESCRIBING

OPTOMETRIST DOCUMENTS CONSULTATION WITH A LICENSED

PHYSICIAN. AS USED IN THIS PARAGRAPH, THE INITIATION OF

TREATMENT MAY, BUT NEED NOT, INCLUDE THE PRESCRIPTION OR

ADMINISTRATION OF PHARMACEUTICAL AGENTS FOR THERAPEUTIC

PURPOSES. THE PRESCRIPTION OF SCHEDULE II CONTROLLED

SUBSTANCES CONTAINING CODEINE AND HYDROCODONE

COMBINATIONS MAY NOT EXCEED A 72-HOUR SUPPLY.

(III) THE REMOVAL OF SUPERFICIAL FOREIGN BODIES FROM

THE OCULAR SURFACE OR ADNEXA .

(IV) EPINEPHRINE AUTO-INJECTORS FOR ANAPHYLAXIS.

(V) THE ORDERING AND INTERPRETATION OF ANGIOGRAPHY

VIA NONINVASIVE IMAGING , WHICH SHALL ONLY INCLUDE OPTICAL

COHERENCE TOMOGRAPHY.

(VI) THE ADMINISTRATION AND PRESCRIPTION OF ALL

LEGEND AND NONLEGEND DRUGS APPROVED BY THE BOARD UNDER

SECTION 4.3 FOR THE TREATMENT OF GLAUCOMA.

[(2) THE ADMINISTRATION AND PRESCRIPTION OF LEGEND AND

NONLEGEND DRUGS AS APPROVED BY THE SECRETARY OF HEALTH AS

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PROVIDED IN SECTION 4.3 FOR TREATMENT OF THE EYE, THE

EYELIDS, THE LACRIMAL SYSTEM AND THE CONJUNCTIVA AND THE

REMOVAL OF SUPERFICIAL FOREIGN BODIES FROM THE OCULAR SURFACE

AND ADNEXA SO LONG AS TREATMENT OF DISEASES OR CONDITIONS OF

THE VISUAL SYSTEM, OTHER THAN GLAUCOMA, AS AUTHORIZED UNDER

THIS PARAGRAPH SHALL NOT CONTINUE BEYOND SIX WEEKS FROM THE

INITIATION OF TREATMENT UNLESS THE PRESCRIBING OPTOMETRIST

DOCUMENTS CONSULTATION WITH A LICENSED PHYSICIAN. AS USED IN

THIS PARAGRAPH, THE INITIATION OF TREATMENT MAY, BUT NEED

NOT, INCLUDE THE PRESCRIPTION OR ADMINISTRATION OF

PHARMACEUTICAL AGENTS FOR THERAPEUTIC PURPOSES.

(3) THE TERM SHALL NOT INCLUDE:

(I) SURGERY, INCLUDING, BUT NOT LIMITED TO, LASER

SURGERY; THE USE OF LASERS FOR THERAPEUTIC PURPOSES; AND

THE USE OF INJECTIONS IN THE TREATMENT OF OCULAR DISEASE;

(II) THE USE OF SCHEDULE I AND SCHEDULE II

CONTROLLED SUBSTANCES;

(III) TREATMENT OF SYSTEMIC DISEASE; AND

(IV) THE TREATMENT OF GLAUCOMA, EXCEPT THAT

OPTOMETRISTS MAY USE ALL TOPICAL PHARMACEUTICAL AGENTS IN

THE TREATMENT OF PRIMARY OPEN ANGLE GLAUCOMA, EXFOLIATION

GLAUCOMA AND PIGMENTARY GLAUCOMA.]

(4) THE TERM SHALL NOT INCLUDE:

(I) SURGERY, INCLUDING, BUT NOT LIMITED TO,

DIAGNOSTIC, EXPLORATORY, PALLIATIVE, THERAPEUTIC,

REHABILITATIVE, COSMETIC, RECONSTRUCTIVE, REFRACTIVE ,

LIGHT-BASED OR LASER SURGERY ; OR THE USE OF LASERS FOR

THERAPEUTIC PURPOSES .

(II) INJECTIONS, OTHER THAN THE USE OF EPINEPHRINE

AUTO-INJECTORS FOR ANAPHYLAXIS.

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(III) THE USE OF SCHEDULE I AND SCHEDULE II

CONTROLLED SUBSTANCES, EXCEPT FOR THE USE OF CODEINE AND

HYDROCODONE COMBINATIONS.

(IV) THE PREVENTION AND TREATMENT OF SYSTEMIC

DISEASE.

* * *

SECTION 2. SECTIONS 4.3 AND 6(B) OF THE ACT ARE AMENDED TO

READ:

SECTION 4.3. APPROVAL OF DRUGS.

DRUGS SHALL BE APPROVED AS FOLLOWS:

(1) ALL DRUGS CURRENTLY APPROVED BY THE SECRETARY OF

HEALTH AND IN USE IN THE PRACTICE OF OPTOMETRY ON THE

EFFECTIVE DATE OF THIS SECTION SHALL BE DEEMED APPROVED UNDER

THIS SECTION.

[(2) WITHIN 90 DAYS OF THE EFFECTIVE DATE OF THIS

SECTION, THE BOARD SHALL SUBMIT A LIST OF DRUGS AUTHORIZED

UNDER THIS ACT TO THE SECRETARY OF HEALTH, WHO, IN

CONSULTATION WITH THE PHYSICIAN GENERAL, SHALL APPROVE OR

DISAPPROVE FOR GOOD CAUSE EACH DRUG. UPON FAILURE OF THE

SECRETARY OF HEALTH TO ACT WITHIN 90 DAYS OF RECEIPT OF THE

LIST OF DRUGS, THE DRUGS SHALL BE DEEMED APPROVED FOR USE

UNDER THIS ACT.

(3) THE STATE BOARD OF OPTOMETRY SHALL PROVIDE THE

SECRETARY OF HEALTH WITH LISTS OF ADDITIONAL DRUGS FOR USE

UNDER THIS ACT AFTER SUCH DRUGS ARE APPROVED BY THE FOOD AND

DRUG ADMINISTRATION, AS PUBLISHED IN THE CODE OF FEDERAL

REGULATIONS. THE SECRETARY OF HEALTH, IN CONSULTATION WITH

THE PHYSICIAN GENERAL, SHALL APPROVE OR DISAPPROVE FOR GOOD

CAUSE ANY SUCH DRUG WITHIN 90 DAYS OF THE RECEIPT OF THE

LIST. UPON FAILURE OF THE SECRETARY OF HEALTH TO ACT WITHIN

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90 DAYS, THE DRUGS SHALL BE DEEMED APPROVED FOR USE UNDER

THIS ACT.]

(4) ON AND AFTER THE EFFECTIVE DATE OF THIS PARAGRAPH,

THE BOARD MAY APPROVE DRUGS FOR ONLY TOPICAL OR ORAL ROUTES

OF ADMINISTRATION, WITH THE EXCEPTION OF DRUGS CLASSIFIED AS

CHEMOTHERAPY DRUGS, FOR USE IN THE PRACTICE OF OPTOMETRY

AFTER THE DRUGS ARE APPROVED BY THE FOOD AND DRUG

ADMINISTRATION, AS PUBLISHED IN THE CODE OF FEDERAL

REGULATIONS.

SECTION 6. EXEMPTIONS AND EXCEPTIONS.

* * *

(B) THE BOARD SHALL PERMIT EXTERNS, WHO ARE [FOURTH YEAR]

OPTOMETRIC STUDENTS, TO PERFORM PROCEDURES AND TESTS FOR THE

SOLE PURPOSE OF INSTRUCTION AND EXPERIENCE UNDER THE DIRECT

SUPERVISION AND CONTROL OF AN OPTOMETRIST LICENSED IN THIS

COMMONWEALTH IF THE PROCEDURES AND TESTS ARE WITHIN THE SCOPE OF

PRACTICE OF THE OPTOMETRIST. NOTHING CONTAINED IN THIS ACT SHALL

BE CONSTRUED TO ENTITLE AN EXTERN TO PRACTICE OPTOMETRY.

* * *

SECTION 3. SECTION 8(A) OF THE ACT IS AMENDED BY ADDING A

PARAGRAPH TO READ:

SECTION 8. VIOLATIONS AND PENALTIES.

(A) * * *

(4) IT IS UNLAWFUL FOR AN OPTOMETRIST TO ADVERTISE A

SERVICE PROHIBITED UNDER THIS ACT. A PERSON CONVICTED OF

VIOLATING THIS PARAGRAPH COMMITS A SUMMARY OFFENSE AND SHALL,

FOR A FIRST OFFENSE, BE SUBJECT TO A FINE OF NOT MORE THAN

$1,000. FOR A PERSON CONVICTED OF A SECOND OR SUBSEQUENT

VIOLATION, BE SUBJECT TO A FINE OF NOT LESS THAN $2,000, AND

THE BOARD MAY IMPOSE A SUSPENSION OF THE PERSON'S LICENSE FOR

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UP TO 30 DAYS, IN ADDITION TO THE FINE.

* * *

SECTION 4. THIS ACT SHALL TAKE EFFECT IN 60 DAYS.

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