Amendment ASA1-AB582

LRBs0204/1

MED:kjf

2017 - 2018 LEGISLATURE

ASSEMBLY SUBSTITUTE AMENDMENT 1, TO ASSEMBLY BILL 582

December 19, 2017 - Offered by Representative Murphy.

AB582-ASA1,1,8 An Act to renumber 448.05 (5) (a) 1. and 2.; to renumber and amend 448.05 (5) (a) (intro.); to amend 441.16 (6), 448.01 (6), 448.20 (1), 448.21 (1) (d), 448.21 (2), 448.21 (3) and Med 8.01 (2); and to create 448.015 (1u), 448.015 (1w), 448.20 (3m), 448.21 (4), 448.62 (2m), 448.62 (7) and 448.695 (4) of the statutes; relating to: delegation of the practice of podiatry, practice of a physician assistant under the supervision of a podiatrist, modifying administrative rules of the Medical Examining Board relating to practice of physician assistants, and providing an exemption from emergency rule procedures.

Analysis by the Legislative Reference Bureau

Generally, under current law, no person may practice podiatry unless the person is licensed as a podiatrist. This substitute amendment creates an exception to this prohibition for an advanced practice nurse prescriber who is providing nonsurgical patient services as directed, supervised, and inspected by a podiatrist.

The substitute amendment also modifies various provisions governing the practice of physician assistants that require a physician assistant to be supervised by a physician to instead allow for supervision of a physician assistant by a podiatrist. The substitute amendment allows a physician assistant who is under the supervision of a podiatrist to engage in the practice of podiatry, except that, like an advanced practice nurse prescriber, the practice of the physician assistant is limited to providing nonsurgical patient services. The substitute amendment allows the Podiatry Affiliated Credentialing Board to promulgate rules regarding the practice of podiatry by physician assistants.

The people of the state of Wisconsin, represented in senate and assembly, do enact as follows:

AB582-ASA1,1 Section 1 . 441.16 (6) of the statutes is amended to read:

AB582-ASA1,2,5 441.16 (6) Nothing in this section prohibits a nurse from issuing a prescription order as an act delegated by a physician, and nothing in this section prohibits an advanced practice nurse certified under this section from issuing a prescription order as an act delegated by a podiatrist.

AB582-ASA1,2 Section 2 . 448.01 (6) of the statutes is amended to read:

AB582-ASA1,2,9 448.01 (6) “Physician assistant" means an individual licensed by the medical examining board to provide medical care with physician supervision and direction or to practice podiatry with podiatrist supervision and direction.

AB582-ASA1,3 Section 3 . 448.015 (1u) of the statutes is created to read:

AB582-ASA1,2,11 448.015 (1u) “Podiatrist" has the meaning given in s. 448.60 (3).

AB582-ASA1,4 Section 4 . 448.015 (1w) of the statutes is created to read:

AB582-ASA1,2,13 448.015 (1w) “Podiatry" has the meaning given in s. 448.60 (4).

AB582-ASA1,5 Section 5 . 448.05 (5) (a) (intro.) of the statutes is renumbered 448.05 (5) (a) and amended to read:

AB582-ASA1,2,18 448.05 (5) (a) The Except as provided in s. 448.695 (4), the board shall promulgate rules establishing licensing standards and practice standards for physician assistants and shall license persons under those rules.

AB582-ASA1,3,2 (b) The board may not grant a license as a physician assistant to an applicant unless the applicant submits evidence satisfactory to the board of all of the following:

AB582-ASA1,6 Section 6 . 448.05 (5) (a) 1. and 2. of the statutes are renumbered 448.05 (5) (b) 1. and 2.

AB582-ASA1,7 Section 7 . 448.20 (1) of the statutes is amended to read:

AB582-ASA1,3,16 448.20 (1) Recommend licensing and practice standards. The council on physician assistants shall develop and recommend to the examining board licensing and practice standards for physician assistants practicing under physicians and shall develop and recommend to the podiatry affiliated credentialing board practice standards for physician assistants practicing under podiatrists. In developing the standards, the council shall consider the following factors: an individual's training, wherever given; experience, however acquired, including experience obtained in a hospital, a physician's or podiatrist's office, the armed services or the federal health service of the United States, or their equivalent as found by the examining board; and education, including that offered by a medical school and the technical college system board.

AB582-ASA1,8 Section 8 . 448.20 (3m) of the statutes is created to read:

AB582-ASA1,3,20 448.20 (3m) Advise podiatry affiliated credentialing board. The council shall advise the podiatry affiliated credentialing board on revising practice standards for physician assistants practicing podiatry.

AB582-ASA1,9 Section 9 . 448.21 (1) (d) of the statutes is amended to read:

AB582-ASA1,3,24 448.21 (1) (d) The practice of podiatry within the meaning of s. 448.60 (4), except when the physician assistant is acting under the supervision and direction of a podiatrist, subject to sub. (4) and the rules promulgated under s. 448.695 (4).

AB582-ASA1,10 Section 10 . 448.21 (2) of the statutes is amended to read:

AB582-ASA1,4,6 448.21 (2) Employee status. No physician assistant may be self-employed. The employer of a physician assistant shall assume legal responsibility for any medical care, including the practice of podiatry, provided by the physician assistant during the employment. The employer of a physician assistant, if other than a licensed physician or podiatrist, shall provide for and not interfere with supervision of the physician assistant by a licensed physician or podiatrist.

AB582-ASA1,11 Section 11 . 448.21 (3) of the statutes is amended to read:

AB582-ASA1,4,12 448.21 (3) Prescriptive authority. A physician assistant may issue a prescription order for a drug or device in accordance with guidelines established by a supervising physician or podiatrist and the physician assistant and with rules promulgated by the board. If any conflict exists between the guidelines and the rules, the rules shall control.

AB582-ASA1,12 Section 12 . 448.21 (4) of the statutes is created to read:

AB582-ASA1,4,16 448.21 (4) Practice of podiatry. A physician assistant who is acting under the supervision and direction of a podiatrist shall be limited to providing nonsurgical patient services.

AB582-ASA1,13 Section 13. 448.62 (2m) of the statutes is created to read:

AB582-ASA1,4,21 448.62 (2m) An advanced practice nurse who is certified to issue prescription orders under s. 441.16 and who is providing nonsurgical patient services as directed, supervised, and inspected by a podiatrist who has the power to direct, decide, and oversee the implementation of the patient services rendered.

AB582-ASA1,14 Section 14 . 448.62 (7) of the statutes is created to read:

AB582-ASA1,4,24 448.62 (7) A physician assistant who is acting under the supervision and direction of a podiatrist, subject to s. 448.21 (4).

AB582-ASA1,15 Section 15 . 448.695 (4) of the statutes is created to read:

AB582-ASA1,5,2 448.695 (4) The affiliated credentialing board shall promulgate rules establishing all of the following:

AB582-ASA1,5,4 (a) Practice standards for a physician assistant practicing podiatry as provided in s. 448.21 (4).

AB582-ASA1,5,6 (b) Requirements for a podiatrist who is supervising a physician assistant as provided in s. 448.21 (4).

AB582-ASA1,16 Section 16 . Med 8.01 (2) of the statutes is amended to read:

AB582-ASA1,5,17 Med 8.01 (2) Physician assistants provide health care services as part of physician-led or podiatrist-led teams, the objectives of which include safe, efficient, and economical health care. The realities of the modern practice of medicine and surgery require supervising physicians and podiatrists and physician assistants to use discretion in delivering health care services, typically at the level of general supervision. The constant physical presence of a supervising physician or podiatrist is often unnecessary. The supervising physician or podiatrist and the physician assistant are jointly responsible for employing more intensive supervision when circumstances require direct observation or hands-on assistance from the supervising physician.

AB582-ASA1,17 Section 17 . Med 8.02 (5x) of the administrative code is created to read:

AB582-ASA1,5,19 Med 8.02 (5x) “Podiatrist” has the meaning given in s. 448.60 (3), Stats.

AB582-ASA1,18 Section 18 . Med 8.05 (4) of the administrative code is amended to read:

AB582-ASA1,5,24 Med 8.05 (4) Licensure; renewal. At the time of licensure and each biennial registration of licensure thereafter, a physician assistant shall list with the board the name and address of the supervising physician or podiatrist and shall notify the board within 20 days of any change of a supervising physician or podiatrist.

AB582-ASA1,19 Section 19. Med 8.07 (1), (2) (i) and (3) of the administrative code are amended to read: