Regular Session 2019-2020 Senate Bill 0870 P.N. 2075

PRIOR PRINTER'S NO. 1221

PRINTER'S NO. 2075

THE GENERAL ASSEMBLY OF PENNSYLVANIA

SENATE BILL

No.

870

Session of

2019

INTRODUCED BY KILLION, BAKER, REGAN, COLLETT, FARNESE, YUDICHAK,

PITTMAN, YAW, BOSCOLA, COSTA AND MARTIN, SEPTEMBER 27, 2019

SENATOR TOMLINSON, CONSUMER PROTECTION AND PROFESSIONAL

LICENSURE, AS AMENDED, OCTOBER 6, 2020

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.

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, ADDED JULY 2, 2019

(P.L.413, NO.68), 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:

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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.

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SECTION 1.1. 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 designee, the Secretary of

Health or his 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] 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 successor has been appointed and qualified, but not longer

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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 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.

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Section 2. Section 13(d) 13(A), (D), (d.1) and (e) of the

act, amended July 2, 2019 (P.L.413, No.68), are amended AND THE

SECTION IS AMENDED BY ADDING A SUBSECTION to read:

Section 13. Physician assistants.

(A) AUTHORIZED SERVICES.--A PHYSICIAN ASSISTANT MAY PERFORM

A MEDICAL SERVICE DELEGATED BY [AN APPROVED PHYSICIAN AND AS

APPROVED BY THE APPROPRIATE BOARD. AN APPROVED PHYSICIAN IS] A

PHYSICIAN IDENTIFIED IN THE WRITTEN AGREEMENT REQUIRED BY

SUBSECTION (E).

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(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

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embraced by the medical doctor community in this Commonwealth]

SUBJECT TO THE PROVISIONS OF SUBSECTIONS (D.2) AND (E).

(d.1) Patient record review.--

(1) The [approved] PRIMARY SUPERVISING 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)] EMPLOYMENT OUTLINED UNDER THE

WRITTEN AGREEMENT.

(ii) The first [12] SIX 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

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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.

(D.2) SUPERVISION.--THE FOLLOWING APPLY:

(1) THE PRIMARY SUPERVISING PHYSICIAN SHALL BE

RESPONSIBLE FOR THE MEDICAL SERVICES THAT A PHYSICIAN

ASSISTANT RENDERS.

(2) A PHYSICIAN ASSISTANT SUBJECT TO SUBSECTION (D.1)

SHALL NOT BE ELIGIBLE TO PERFORM A MEDICAL SERVICE WITHOUT

THE SUPERVISION OF AN APPROVED PHYSICIAN.

(3) THE PRIMARY SUPERVISING PHYSICIAN MAY REQUIRE

PERSONAL REVIEW OF A SELECTED NUMBER OF PATIENT RECORDS

COMPLETED BY THE PHYSICIAN ASSISTANT IN ORDER TO MAINTAIN THE

SUPERVISORY ROLE OUTLINED IN THE WRITTEN AGREEMENT.

(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.

(1.1) IDENTIFIES AND IS SIGNED BY AN ALTERNATIVE

SUPERVISING PHYSICIAN IN ORDER TO MAINTAIN THE CONTINUITY OF

CARE IF THE PRIMARY SUPERVISING PHYSICIAN CANNOT FULFILL THE

RESPONSIBILITIES. IF THE ALTERNATIVE SUPERVISING PHYSICIAN

BECOMES THE PRIMARY SUPERVISING PHYSICIAN, THE PHYSICIAN,

PHYSICIAN ASSISTANT OR THEIR DESIGNEE HAS 30 DAYS TO MAKE THE

BOARD AWARE OF THE CHANGE.

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(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] physician

as having the primary responsibility for supervising [and

directing] the 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

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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.

(5.1) IS FILED WITH THE BOARD BY THE PRIMARY SUPERVISING

PHYSICIAN, THE PHYSICIAN ASSISTANT OR A DELEGATE OF THE

PRIMARY SUPERVISING PHYSICIAN AND PHYSICIAN ASSISTANT AND A

COPY MAINTAINED BY THE PRIMARY SUPERVISING PHYSICIAN AT THE

PRACTICE OR HEALTH CARE FACILITY 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 PRACTICE OR THAT THE PRIMARY SUPERVISING PHYSICIAN

UTILIZED THE PHYSICIAN ASSISTANT OUTSIDE THE SCOPE OF

PRACTICE BECAUSE THE PRIMARY SUPERVISING PHYSICIAN OR

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PHYSICIAN ASSISTANT PERMITTED ANOTHER PERSON TO REPRESENT TO

THE BOARD THAT THE DESCRIPTION HAD BEEN APPROVED BY THE

PRIMARY SUPERVISING PHYSICIAN OR PHYSICIAN ASSISTANT. A

WRITTEN AGREEMENT GOES INTO EFFECT ONCE IT IS FILED WITH 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 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 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 WRITTEN agreement. A

supervising physician shall determine the number of physician

assistants supervised at any one time. PRIMARY SUPERVISING

PHYSICIAN MAY SUPERVISE UP TO SEVEN PHYSICIAN ASSISTANTS AT ANY

ONE TIME.

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Section 3. 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 4. This act shall take effect in 60 days.

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