PRINTER'S NO. 1221
THE GENERAL ASSEMBLY OF PENNSYLVANIA
SENATE BILL
No.
870
Session of
2019
INTRODUCED BY KILLION, BAKER, REGAN, COLLETT, FARNESE, YUDICHAK,
PITTMAN, YAW AND BOSCOLA, SEPTEMBER 27, 2019
REFERRED TO CONSUMER PROTECTION AND PROFESSIONAL LICENSURE,
SEPTEMBER 27, 2019
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 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 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 members appointed by the Governor, one of whom
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shall be a physician assistant, six 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
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.
* * *
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:
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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
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
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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
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
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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.
[(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
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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
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. 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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