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    South Carolina General Assembly.doc South Carolina General Assembly.doc Document Transcript

    • 1 South Carolina General Assembly 2 116th Session, 2005-2006 3 4 S. 995 5 6 STATUS INFORMATION 7 8 General Bill 9 Sponsors: Senators Hayes, Cromer, Pinckney and Bryant 10 Document Path: l:councilbillsnbd11965ac06.doc 11 Companion/Similar bill(s): 4015 12 13 Introduced in the Senate on January 10, 2006 14 Currently residing in the Senate Committee on Medical Affairs 15 16 Summary: Physicians Assistant Act 17 18 19 HISTORY OF LEGISLATIVE ACTIONS 20 21 Date Body Action Description with journal page number 22 12/13/2005 Senate Prefiled 23 12/13/2005 Senate Referred to Committee on Medical Affairs 24 1/10/2006 Senate Introduced and read first time SJ-32 25 1/10/2006 Senate Referred to Committee on Medical Affairs SJ-32 26 27 View the latest legislative information at the LPITS web site 28 29 30 VERSIONS OF THIS BILL 31 32 12/13/2005 33
    • 1 2 3 4 5 6 7 8 9 A BILL 10 11 TO AMEND SECTION 40-47-910, CODE OF LAWS OF 12 SOUTH CAROLINA, 1976, RELATING TO DEFINITION OF 13 TERMS IN THE SOUTH CAROLINA PHYSICIAN 14 ASSISTANTS PRACTICE ACT, SO AS TO CLARIFY 15 CERTAIN TERMS; TO AMEND SECTION 40-47-935, 16 RELATING TO FUNCTIONS A PHYSICIAN ASSISTANT 17 MAY PERFORM, SO AS TO CLARIFY THAT ONLY A 18 PERMANENTLY LICENSED PHYSICIAN ASSISTANT MAY 19 PRESCRIBE MEDICATIONS; TO AMEND SECTION 20 40-47-940, RELATING TO PHYSICIAN ASSISTANT LICENSE 21 APPLICATION PROCEDURES, SO AS TO REVISE 22 PROCEDURES CONCERNING ISSUANCE OF TEMPORARY 23 AUTHORIZATIONS AND PERMANENT LICENSURE; TO 24 AMEND SECTION 40-47-945, RELATING TO PERMANENT 25 LICENSURE REQUIREMENTS FOR PHYSICIAN 26 ASSISTANTS, SO AS TO REVISE ACCREDITATION 27 ENTITIES AND TO REQUIRE AN APPLICANT TO APPEAR 28 BEFORE A MEMBER OF THE BOARD OF MEDICAL 29 EXAMINERS OR A BOARD DESIGNEE WITH HIS SCOPE OF 30 PRACTICE GUIDELINES AND TO DEMONSTRATE 31 KNOWLEDGE OF THIS PRACTICE ACT; TO AMEND 32 SECTION 40-47-950, RELATING TO LIMITED LICENSURE 33 REQUIREMENTS FOR A PHYSICIAN ASSISTANT, SO AS 34 TO REVISE ACCREDITATION ENTITIES AND TO PROVIDE 35 THAT WHEN AN APPLICANT APPEARS FOR LICENSURE, 36 IT MAY BE BEFORE A DESIGNEE OF THE BOARD OF 37 MEDICAL EXAMINERS; TO AMEND SECTION 40-47-955, 38 RELATING TO THE REQUIREMENT FOR SUPERVISING 39 PHYSICIAN ASSISTANTS, SO AS TO DESIGNATE 40 REQUIREMENTS FOR ON-SITE AND OFF-SITE PRACTICE 41 SETTINGS, TO CLARIFY ON-SITE REQUIREMENTS 42 CONCERNING THE SUPERVISING PHYSICIAN BEING 1 [995] 1
    • 1 PHYSICALLY PRESENT AT THE LOCATION WHERE THE 2 PHYSICIAN ASSISTANT IS PROVIDING SERVICES, AND 3 TO ESTABLISH OFF-SITE PRACTICE REQUIREMENTS, 4 INCLUDING REQUIRING A PHYSICIAN ASSISTANT TO 5 HAVE CERTAIN PERIODS OF CLINICAL EXPERIENCE 6 BEFORE PRACTICING OFF-SITE, ESTABLISHING PERIODS 7 OF TIME THE SUPERVISING PHYSICIAN MUST BE 8 PHYSICALLY AT THE LOCATION WHERE THE PHYSICIAN 9 ASSISTANT IS PROVIDING SERVICES, AND REVISING 10 THE TIME WITHIN WHICH THE SUPERVISING PHYSICIAN 11 MUST REVIEW THE PHYSICIAN ASSISTANT’S CHARTS; 12 TO AMEND SECTION 40-47-965, RELATING TO THE 13 AUTHORITY OF A PHYSICIAN ASSISTANT TO PRESCRIBE 14 DRUG THERAPY, SO AS TO EXPAND THE AUTHORITY TO 15 PRESCRIBE CONTROLLED SUBSTANCES AND TO 16 ESTABLISH REQUIREMENTS TO OBTAIN THIS 17 AUTHORITY, INCLUDING ESTABLISHING CONTACT 18 HOURS, CONTINUING EDUCATION, AND BIENNIAL 19 SUPERVISING PHYSICIAN REVIEW; TO AMEND SECTION 20 40-47-970, RELATING TO ACTS A PHYSICIAN ASSISTANT 21 IS PROHIBITED FROM PERFORMING, SO AS TO INCLUDE 22 A MEDICAL ACT, TASK, OR FUNCTION OUTSIDE THE 23 USUAL PRACTICE OF THE SUPERVISING PHYSICIAN; TO 24 AMEND SECTION 40-47-980, RELATING TO TREATMENT 25 OF PATIENTS IN CHRONIC CARE AND LONG-TERM CARE 26 FACILITIES, SO AS TO CLARIFY THAT A PHYSICIAN 27 ASSISTANT’S ALTERNATE SUPERVISOR IN SUCH CASES 28 MUST BE A PHYSICIAN SUPERVISOR; TO AMEND 29 SECTION 40-47-1000, RELATING TO PRIVILEGED 30 COMMUNICATIONS IN INVESTIGATIONS AND HEARINGS 31 REGARDING A PHYSICIAN ASSISTANT, SO AS TO 32 DELETE THESE PROVISIONS AND TO PROVIDE THAT 33 INVESTIGATIONS AND DISCIPLINARY PROCEEDINGS 34 MUST BE CONDUCTED IN ACCORDANCE WITH 35 PROVISIONS CONCERNING PHYSICIANS IN SUCH 36 MATTERS; TO AMEND SECTION 40-47-1010, RELATING TO 37 PHYSICIAN ASSISTANT LICENSURE RENEWAL, SO AS TO 38 PROVIDE THAT RENEWAL MUST BE BIENNIAL AND 39 THAT THE LICENSEE MUST COMPLY WITH CONTINUING 40 EDUCATION REQUIREMENTS; AND TO AMEND SECTION 41 40-47-1015, RELATING TO PHYSICIAN ASSISTANT 42 LICENSURE FEES, SO AS TO FURTHER SPECIFY 43 PROVISIONS FOR ADJUSTING THESE FEES BIENNIALLY. 1 [995] 2
    • 1 2 Be it enacted by the General Assembly of the State of South 3 Carolina: 4 5 SECTION 1. Section 40-47-910(1) and (6) of the 1976 Code, as 6 added by Act 359 of 2000, are amended to read: 7 8 “(1) ‘Alternate physician supervisor’ or ‘alternate supervising 9 physician’ means a South Carolina licensed physician currently 10 possessing an active, unrestricted permanent license to practice 11 medicine in South Carolina who accepts the responsibility to 12 supervise a physician assistant’s activities in the absence of the 13 supervising physician and this physician is approved by the board 14 physician supervisor in writing in the scope of practice guidelines. 15 16 (6) ‘Physician supervisor or supervising physician’ means a 17 South Carolina licensed physician currently possessing an active, 18 unrestricted permanent license to practice medicine in South 19 Carolina who is approved to supervise serve as a supervising 20 physician for no more than two physician assistants. The 21 physician supervisor is the individual who is responsible for 22 supervising a physician assistant’s activities.” 23 24 SECTION 2. Section 40-47-935 of the 1976 Code, as added by 25 Act 359 of 2000, is amended to read: 26 27 “Section 40-47-935. Physician assistants may perform: 28 (1) medical acts, tasks, or functions with written scope of 29 practice guidelines under physician supervision; 30 (2) those duties and responsibilities, including the prescribing 31 and dispensing of drugs and medical devices, that are lawfully 32 delegated by their supervising physicians. However, only 33 physician assistants holding a permanent license may prescribe 34 drug therapy as provided in this article. 35 A physician assistant is an agent of his or her supervising 36 physician in the performance of all practice related activities 37 including, but not limited to, the ordering of diagnostic, 38 therapeutic, and other medical services.” 39 40 SECTION 3. Section 40-47-940 of the 1976 Code, as added by 41 Act 359 of 2000, is amended to read: 42 1 [995] 3
    • 1 “Section 40-47-940. (A) An application must be submitted to 2 the board on forms supplied by the board. The application must be 3 complete in every detail before it may be approved and must be 4 accompanied by a nonrefundable fee. As part of the application 5 process, the supervising physician and physician assistant must 6 clearly specify clearly in detail those medical acts, tasks, or 7 functions for which approval is being sought. The specific medical 8 acts, tasks, or functions must be included in the scope of practice 9 guidelines, and the scope of practice guidelines must accompany 10 the application. 11 (B) When a board member or board designee or the 12 administrative staff of the board has reviewed the entire 13 application for completeness and correctness, and has found the 14 applicant eligible, and the supervising physician and physician 15 assistant have appeared before the committee or a designated board 16 member, determined the eligibility or appropriateness of the 17 application a temporary license authorization may be issued 18 immediately. At the next committee board meeting the entire 19 application, including scope of practice guidelines, must be 20 considered and, if qualified, the committee may recommend to the 21 board that a permanent license be issued to the physician assistant. 22 If the committee declines to recommend issuance of a permanent 23 license, the committee may extend or withdraw the temporary 24 license may be recommended for approval for a permanent license 25 or other authorization consistent with this article. If a temporary 26 authorization is not considered appropriate, the application must be 27 reviewed by the committee and may be recommended to the board 28 for approval as presented to or modified by the committee.” 29 30 SECTION 4. Section 40-47-945 of the 1976 Code, as added by 31 Act 359 of 2000, is amended to read: 32 33 “Section 40-47-945. (A) Except as otherwise provided in this 34 article, an individual must shall obtain a permanent license from 35 the board before the individual may practice as a physician 36 assistant. The board shall grant a permanent license as a physician 37 assistant to an applicant who has: 38 (1) submitted a completed application on forms provided by 39 the board; 40 (2) paid the nonrefundable application fees established in 41 this article; 42 (3) successfully completed an educational program for 43 physician assistants approved by the Commission on Accredited 1 [995] 4
    • 1 Allied Health Education Programs Accreditation Review 2 Commission on Education for the Physician Assistant or its 3 predecessor or its successor organization; 4 (4) successfully completed the NCCPA certifying 5 examination and provide documentation that he or she the 6 applicant possesses a current, active, NCCPA certificate; 7 (5) certified that he or she the applicant is mentally and 8 physically able to engage safely in practice as a physician 9 assistant; 10 (6) no licensure, certificate, or registration as a physician 11 assistant under current discipline, revocation, suspension, 12 probation, or investigation for cause resulting from the applicant’s 13 practice as a physician assistant; 14 (7) good moral character; 15 (8) submitted to the board any other information the board 16 considers necessary to evaluate the applicant’s qualifications; 17 (9) appeared before a board member or board designee with 18 his or her the applicant’s supervising physician and all original 19 diplomas and certificates and demonstrated knowledge of the 20 contents of this article. A temporary authorization to practice may 21 be issued as provided in Section 40-47-940 pending completion of 22 this requirement and subject to satisfactory interview as provided 23 below; and 24 (10) successfully completed an examination administered by 25 the committee on the statutes and regulations regarding physician 26 assistant practice and supervision. 27 (B) Not later than ninety days from the date a temporary 28 authorization is issued, each applicant shall appear before a board 29 member or board designee with the applicant’s supervising 30 physician and scope of practice guidelines and demonstrate 31 knowledge of the contents of this article. Failure to appear within 32 the prescribed time automatically results in the immediate 33 invalidation of the authorization to practice pending compliance 34 and further order of the board. If approved, a permanent license 35 may be issued immediately. If not approved, the application must 36 be reviewed by the committee and may be recommended to the 37 board for approval as presented to or modified by the committee. 38 (C) The supervising physician of a limited licensee must be 39 physically must be present on the premises at all times when the 40 limited licensee is performing any a task. No on-the-job training, 41 or task not listed on the application, may be approved for a limited 42 license holder.” 43 1 [995] 5
    • 1 SECTION 5. Section 40-47-950 of the 1976 Code, as added by 2 Act 359 of 2000, is amended to read: 3 4 “Section 40-47-950. (A) The board may issue a limited 5 physician assistant license to an applicant who has: 6 (1) submitted a completed application on forms provided by 7 the board; 8 (2) paid the nonrefundable application fees established by 9 this regulation; 10 (3) successfully completed an educational program for 11 physician assistants approved by the American Medical 12 Association Counsel on Medical Education Accreditation Review 13 Commission on Education for the Physician Assistant or its 14 predecessor or successor organization; 15 (4) never previously failed two consecutive NCCPA 16 certifying examinations and has registered for, or intends to 17 register to take the next offering of, the NCCPA examination; 18 (5) certified that he or she is the applicant mentally and 19 physically is able to engage safely in practice as a physician 20 assistant; 21 (6) no licensure, certificate, or registration as a physician 22 assistant under current discipline, revocation, suspension, 23 probation, or investigation for cause resulting from the applicant’s 24 practice as a physician assistant; 25 (7) good moral character; 26 (8) submitted to the board any other information the board 27 considers necessary to evaluate the applicant’s qualifications; 28 (9) appeared before a board member with his or her or board 29 designee with the applicant’s supervising physician and all original 30 diplomas and certificates and demonstrated knowledge of the 31 contents of this article; and 32 (10) successfully completed an examination administered by 33 the committee on the statutes and regulations regarding physician 34 assistant practice and supervision. 35 (B) A limited license is not renewable and is valid only until 36 the results of a limited licensee’s two consecutive NCCPA 37 certifying examinations are reported to the board. When a limited 38 licensee has failed two consecutive NCCPA certifying 39 examinations, or fails one exam and does not take the NCCPA 40 certifying examination at the next opportunity or, after applying 41 for a limited license, fails to register for the next offering of the 42 examination, the limited license is immediately is void and the 1 [995] 6
    • 1 applicant is no longer eligible to apply for further limited 2 licensure. 3 (C) The supervising physician of a limited licensee must be 4 physically must be present on the premises at all times when the 5 limited licensee is performing any a task. No on-the-job training, 6 or task not listed on the application, may be approved for a limited 7 license holder.” 8 9 SECTION 6. Section 40-47-955 of the 1976 Code, as added by 10 Act 359 of 2000, is amended to read: 11 12 “Section 40-47-955. (A) The supervising physician is 13 responsible for all aspects of the physician assistant’s practice. 14 Supervision must be continuous but must not be construed as 15 necessarily requiring the physical presence of the supervising 16 physician at the time and place where the services are rendered, 17 except as otherwise required for limited licensees. The supervising 18 physician shall identify the physician assistant’s scope of practice 19 and determine the delegation of medical acts, tasks, or functions. 20 All Medical acts, tasks, or functions must be defined in approved 21 written guidelines which must be appropriate to the physician 22 assistant’s ability and knowledge. 23 (B) In an on-site practice setting, the supervising physician or 24 alternate supervising physician must be physically must be present 25 at the same location as the physician assistant at least seventy-five 26 percent of the time each month the physician assistant is providing 27 services at the same location as the supervising physician or 28 alternate supervising physician. A physician assistant must have 29 six months’ clinical experience with the current supervising 30 physician before being permitted to practice in the absence of the 31 supervising physician. The physician assistant may not provide 32 services in the absence of his or her the supervising physician or 33 alternate supervising physician for a period not to exceed more 34 than seven consecutive days each month without the prior written 35 permission from approval of the board. The board may grant in 36 writing exceptions to the seventy-five percent direct supervision 37 requirement provided for in this subsection. 38 (C) For off-site practice, a physician assistant may not practice 39 at any location must have six months of clinical experience with 40 the current supervising physician before being permitted to 41 practice at a location off-site from the supervising physician, 42 except that a physician assistant who has at least two years 43 continuous practice in South Carolina in the same specialty will be 1 [995] 7
    • 1 permitted to practice at a location off-site from the supervising 2 physician after three months clinical experience with the 3 supervising physician and upon request of the supervising 4 physician. This three month requirement may be waived for 5 experienced physician assistants and supervisors upon 6 recommendation of the committee and approval by the board. The 7 off-site location may not be more than forty-five miles or sixty 8 minutes travel time from the supervising physician or alternate 9 supervising physician without written approval of the board. The 10 supervising physician or alternate supervising physician must be 11 physically present at the off-site location not less than twenty 12 percent of the time each month the physician assistant is providing 13 services there. Notice of off-site practice must be filed with the 14 administrative staff of the board before off-site practice may be 15 authorized. The supervising physician or alternate must review, 16 initial, and date the off-site physician assistant’s charts within 17 seventy-two hours of patients seen by the physician assistant when 18 the supervising physician or alternate was not present at the 19 practice site not later than five working days from the date of 20 service if not sooner as proportionate to the acuity of care and 21 practice setting. 22 (D) A supervising physician may not supervise more than two 23 physician assistants. 24 (D)(E) Upon written request, and recommendation of the 25 committee, the board may authorize exceptions to the requirements 26 of this section.” 27 28 SECTION 7. Section 40-47-965 of the 1976 Code, as added by 29 Act 359 of 2000, is amended to read: 30 31 “Section 40-47-965. (A) If the written scope of practice 32 guidelines authorize the physician’s assistant to prescribe drug 33 therapy: 34 (1) prescriptions for authorized drugs and devices shall 35 comply with all applicable state and federal laws; 36 (2) prescriptions must be limited to drugs and devices 37 authorized by the supervising physician and set forth in the written 38 scope of practice guidelines; 39 (3) prescriptions must be signed by the physician assistant 40 and must bear the physician assistant’s identification number as 41 assigned by the board and all prescribing numbers required by law. 42 The preprinted prescription form shall include both the physician 43 assistant’s and physician’s name, address, and phone number 1 [995] 8
    • 1 pre-printed on the form and shall comply with the provisions of 2 Section 39-24-40; 3 (4) drugs or devices prescribed must be specifically 4 documented in the patient record; 5 (5) the physician assistant may request, receive, and sign for 6 professional samples of drugs authorized in the written scope of 7 practice guidelines, except for controlled substances in Schedules 8 Schedule II through IV, and may distribute professional samples to 9 patients in compliance with appropriate federal and state 10 regulations and the written scope of practice guidelines. 11 (B) When applying for controlled substance prescriptive 12 authority, the applicant shall comply with the following 13 requirements: 14 (1) the physician assistant shall provide evidence of 15 completion of sixty contact hours of education in 16 pharmacotherapeutics acceptable to the board before application; 17 (2) the physician assistant shall provide at least fifteen 18 contact hours of education in controlled substances acceptable to 19 the board; 20 (3) every two years, the physician assistant shall provide 21 documentation of four continuing education contact hours in 22 prescribing controlled substances acceptable to the board; and 23 (4) the physician assistant and supervising physician must 24 read and sign a document approved by the board describing the 25 management of expanded controlled substances prescriptive 26 authority for physician assistants in South Carolina which must be 27 kept on file for review. Within the two year period, the physician 28 assistant and the supervising physician periodically shall review 29 this document and the physician assistant’s prescribing practices to 30 ensure proper prescribing procedures are followed. This review 31 must be documented in writing with a copy kept at each practice 32 site. 33 (B)(C) A physician assistant’s prescriptive authorization may be 34 terminated by the board if the physician assistant: 35 (1) practices outside the written scope of practice guidelines; 36 (2) violates any state or federal law or regulation applicable 37 to prescriptions; or 38 (3) violates a state or federal law applicable to physician 39 assistants.” 40 41 SECTION 8. Section 40-47-970 of the 1976 Code, as added by 42 Act 359 of 2000, is amended to read: 43 1 [995] 9
    • 1 “Section 40-47-970. A physician assistant may not: 2 (1) perform a medical act, task, or function which has not been 3 listed and approved on the scope of practice guidelines currently 4 on file with the board; 5 (2) prescribe drugs, medications, or devices not specifically 6 authorized by the supervising physician and documented in the 7 written scope of practice guidelines; 8 (3) prescribe, under any circumstances, controlled substances 9 in Schedules Schedule II through IV; 10 (4) perform a medical act, task, or function that is outside the 11 usual practice of the supervising physician.” 12 13 SECTION 9. Section 40-47-980 of the 1976 Code, as added by 14 Act 359 of 2000, is amended to read: 15 16 “Section 40-47-980. In the treatment of patients in chronic care 17 and long-term care facilities including, but not limited to, nursing 18 homes or chronic dialysis units, the supervising physician must 19 conduct the initial patient visit. Thereafter, the physician 20 supervisor or alternate physician supervisor must see the patient 21 every six months for routine evaluation.” 22 23 SECTION 10. Section 40-47-1000(D) of the 1976 Code, as 24 added by Act 359 of 2000, is amended to read: 25 26 “(D) Every communication, whether oral or written, made by or 27 on behalf of any person or firm to the board or any person 28 designated by the board to investigate or otherwise hear matters 29 relating to the revocation, suspension, or other restriction on a 30 license or other discipline of a license holder, whether by way of 31 complaint or testimony, is privileged and exempt from disclosure 32 for any reason except to the extent disclosed in proceedings before 33 the board. No action or proceeding, civil or criminal, may lie 34 against the person or firm for the communication except upon 35 other proof that the communication was made with malice. 36 Investigations and disciplinary proceedings under this article must 37 be conducted in accordance with the provisions of Article 1.” 38 39 SECTION 11. Section 40-47-1010 of the 1976 Code, as added 40 by Act 359 of 2000, is amended to read: 41 42 “Section 40-47-1010. A physician assistant’s license must be 43 renewed on or before the first of January of each licensure period. 1 [995] 10
    • 1 Upon payment of the nonrefundable renewal fee provided for in 2 Section 40-47-1015 and submission of documentation that the 3 physician assistant certificate with the National Commission on 4 Certification of Physician Assistants, Inc., or its successor, is 5 active and current, the board shall renew the physician assistant’s 6 license. A license issued pursuant to this chapter may be renewed 7 biennially or as otherwise provided by the board and department. 8 A person who has not demonstrated continuing education, as 9 required by this article, is not eligible for issuance or renewal of an 10 authorization to practice.” 11 12 SECTION 12. Section 40-47-1015 of the 1976 Code, as added 13 by Act 359 of 2000, is amended to read: 14 15 “Section 40-47-1015. (A) Fees for physician assistant licensure 16 are established as follows: 17 (1) initial licensing fee, not to exceed five hundred dollars; 18 (2) renewal of license fee, not to exceed one hundred and fifty 19 dollars; 20 (3) late renewal fee, not to exceed the renewal fee doubled; 21 (4) reactivation application fee, not to exceed two hundred 22 dollars; 23 (5) change in supervisor fee, not to exceed one hundred and 24 fifty dollars; 25 (6) additional primary supervisor for dual employment fee, not 26 to exceed one hundred and fifty dollars. 27 (B) Fees may be adjusted biennially pursuant to Section 28 40-1-50 to ensure that they are sufficient but not excessive to cover 29 expenses including the total of the direct and indirect costs to the 30 State for the operations of the board committee.” 31 32 SECTION 13. This act takes effect upon approval by the 33 Governor. 34 ----XX---- 35 1 [995] 11