LRB-0196/2
MED&TJD:wlj&kjf
2019 - 2020 LEGISLATURE
October 18, 2019 - Introduced by Senators Bernier, Kooyenga, Hansen,
Tiffany,
Schachtner and Bewley, cosponsored by Representatives VanderMeer,
Edming, Considine, Quinn, Felzkowski, Rohrkaste, Mursau, Sortwell,
James, Summerfield, Tittl, Krug, Vruwink, Spiros, Dittrich, Anderson,
Doyle, Kulp, Oldenburg and Ramthun. Referred to Committee on Elections,
Ethics and Rural Issues.
SB515,2,6
1An Act to repeal 15.407 (2), 50.01 (4p), 252.01 (5), 448.01 (6), 448.03 (1) (b),
2448.03 (3) (e), 448.04 (1) (f), 448.05 (5), 448.20, 448.21, 448.40 (2) (f), 448.695 (4)
3and 450.01 (15r);
to renumber 448.038;
to amend 15.08 (1m) (b), 16.417 (1)
4(e) 3m., 46.03 (44), 48.981 (2m) (b) 1., 49.45 (9r) (a) 7. a., 50.08 (2), 50.39 (3),
550.60 (1), 55.14 (8) (b), 69.01 (6g), 70.47 (8) (intro.), 97.67 (5m) (a) 3., 118.2925
6(1) (f), 146.38 (1) (b) 1., 146.81 (1) (d), 146.81 (1) (i), 146.81 (1) (j), 146.82 (3) (a),
7146.89 (1) (r) 1., 146.997 (1) (d) 5., 155.01 (7), 252.15 (1) (am), 252.15 (1) (ar) 1.,
8255.07 (1) (d), 255.07 (7), 257.01 (5) (a), 257.01 (5) (b), 343.16 (5) (a), 440.035
9(2m) (b), 440.035 (2m) (c) 1. (intro.), 448.015 (4) (am) 2., 448.02 (1), 448.03 (2)
10(a), 448.03 (2) (e), 448.03 (2) (k), 448.03 (5) (b), 448.035 (2) to (4), 448.037 (2) (a)
11(intro.) and (b) and (3), 448.62 (7), 450.01 (16) (hm) 3., 450.10 (3) (a) 5., 450.11
12(1), 450.11 (1g) (b), 450.11 (1i) (a) 1., 450.11 (1i) (b) 2. c., 450.11 (1i) (c) 2., 450.11
13(8) (b), 462.02 (2) (e), 462.04, 895.48 (1m) (a) (intro.), 961.01 (19) (a) and 971.14
14(4) (a); and
to create 15.405 (4), 49.45 (9r) (a) 7. am., 69.18 (1) (ck), 146.81 (1)
1(hr), 146.997 (1) (d) 13m., 180.1901 (1m) (h), 450.10 (3) (a) 12., 450.11 (1i) (b) 2.
2cm., 450.11 (8) (f), chapter 461 and 990.01 (27s) of the statutes;
relating to:
3regulation of physician assistants, creating a Physician Assistant Examining
4Board, extending the time limit for emergency rule procedures, providing an
5exemption from emergency rule procedures, granting rule-making authority,
6and providing a penalty.
Analysis by the Legislative Reference Bureau
This bill makes changes with respect to the licensure, regulation, and practice
of physician assistants (PAs).
Under current law, PAs are defined as individuals who are licensed to provide
medical care with physician supervision and direction. The Medical Examining
Board licenses and regulates PAs as well as physicians and certain other professions.
The Medical Examining Board is composed of ten physicians and three public
members and is authorized to promulgate rules establishing licensing and practice
standards for PAs.
This bill transfers licensure and regulation of PAs to the newly created
Physician Assistant Examining Board. The new board is composed of seven PAs, one
member who may be either a physician or a PA, and one public member. In addition,
the bill makes various changes to the licensure, regulation, and practice of PAs,
including all of the following:
1. Instead of requiring that a PA practice under the supervision and direction
of a physician, requires, subject to certain exceptions, that a PA who provides care
to patients maintain and provide to the board upon request either 1) evidence that,
pursuant to the physician assistant's employment, there is a physician who is
primarily responsible for the overall direction and management of the physician
assistant's professional activities and for assuring that the services provided by the
physician assistant are medically appropriate or 2) a written collaborative
agreement with a physician or, if the physician assistant's practice is limited to the
practice of podiatry, a podiatrist, which must describe the PA's scope of practice and
include other information as required by the board. However, the bill provides that
a PA is individually and independently responsible for the quality of the care he or
she renders.
2. Defines a PA's practice similarly to the definition of the practice of medicine
and surgery. The bill also explicitly provides that a PA may prescribe, dispense, and
administer drugs and may serve as a primary or specialty care provider. The bill
requires a PA to limit his or her practice to the scope of his or her experience,
education, and training, and retains a number of limitations on the practice of PAs.
3. Includes a number of additional provisions with respect to the obligations
of PAs. These include a requirement that a PA have in effect malpractice liability
insurance coverage when practicing, subject to certain exceptions and other
provisions.
4. Establishes licensure requirements for PAs, which differ in a number of
respects from the requirements under current law, including that PAs submit
additional information, including an employment history, with a licensure
application. Under the bill, the board must require continuing education for PAs.
Currently, PAs are not required to complete continuing education.
5. Specifies various grounds for professional discipline of a PA by the board and
allows the board to impose professional discipline consistent with other professions.
Because this bill creates a new crime or revises a penalty for an existing crime,
the Joint Review Committee on Criminal Penalties may be requested to prepare a
report.
For further information see the state fiscal estimate, which will be printed as
an appendix to this bill.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
SB515,1
1Section
1. 15.08 (1m) (b) of the statutes is amended to read:
SB515,3,122
15.08
(1m) (b) The public members of the chiropractic examining board, the
3dentistry examining board, the hearing and speech examining board, the medical
4examining board, the physical therapy examining board,
the perfusionists
5examining council,
the respiratory care practitioners examining council
and council
6on, the physician
assistants
assistant examining board, the board of nursing, the
7nursing home administrator examining board, the veterinary examining board, the
8optometry examining board, the pharmacy examining board, the marriage and
9family therapy, professional counseling, and social work examining board, the
10psychology examining board, and the radiography examining board shall not be
11engaged in any profession or occupation concerned with the delivery of physical or
12mental health care.
SB515,2
13Section
2. 15.405 (4) of the statutes is created to read:
SB515,4,3
115.405
(4) Physician assistant examining board. (a) There is created in the
2department of safety and professional services a physician assistant examining
3board consisting of the following members appointed for staggered 4-year terms:
SB515,4,44
1. Seven physician assistants licensed under ch. 461.
SB515,4,65
2. One individual who is either a physician licensed under subch. II of ch. 448
6or a physician assistant licensed under ch. 461.
SB515,4,77
3. One public member.
SB515,4,108
(b) The governor may appoint a physician assistant to the physician assistant
9examining board under par. (a) 2. only if the governor has determined that there is
10no suitable physician who is willing to serve on the board.
SB515,3
11Section
3. 15.407 (2) of the statutes is repealed.
SB515,4
12Section 4
. 16.417 (1) (e) 3m. of the statutes is amended to read:
SB515,4,1413
16.417
(1) (e) 3m. A physician assistant who is licensed under s.
448.04 (1) (f) 14461.07.
SB515,5
15Section 5
. 46.03 (44) of the statutes is amended to read:
SB515,4,2416
46.03
(44) Sexually transmitted disease treatment information. Prepare and
17keep current an information sheet to be distributed to a patient by a physician,
18physician assistant, or certified advanced practice nurse prescriber providing
19expedited partner therapy to that patient under s. 448.035
or 461.035. The
20information sheet shall include information about sexually transmitted diseases and
21their treatment and about the risk of drug allergies. The information sheet shall also
22include a statement advising a person with questions about the information to
23contact his or her physician, pharmacist, or local health department, as defined in
24s. 250.01 (4).
SB515,6
25Section
6. 48.981 (2m) (b) 1. of the statutes is amended to read:
SB515,5,3
148.981
(2m) (b) 1. “Health care provider" means a physician, as defined under
2s. 448.01 (5), a physician assistant, as defined under s.
448.01 (6) 461.01 (3), or a
3nurse holding a license under s. 441.06 (1) or a license under s. 441.10.
SB515,7
4Section 7
. 49.45 (9r) (a) 7. a. of the statutes is amended to read:
SB515,5,65
49.45
(9r) (a) 7. a. A physician
or physician assistant licensed under subch. II
6of ch. 448.
SB515,8
7Section 8
. 49.45 (9r) (a) 7. am. of the statutes is created to read:
SB515,5,88
49.45
(9r) (a) 7. am. A physician assistant licensed under ch. 461.
SB515,9
9Section
9. 50.01 (4p) of the statutes is repealed.
SB515,10
10Section
10. 50.08 (2) of the statutes is amended to read:
SB515,5,1511
50.08
(2) A physician, an advanced practice nurse prescriber certified under
12s. 441.16 (2), or a physician assistant
licensed under ch. 448, who prescribes a
13psychotropic medication to a nursing home resident who has degenerative brain
14disorder shall notify the nursing home if the prescribed medication has a boxed
15warning under
21 CFR 201.57.
SB515,11
16Section
11. 50.39 (3) of the statutes is amended to read:
SB515,5,2517
50.39
(3) Facilities governed by ss. 45.50, 48.62, 49.70, 49.72, 50.02, 51.09, and
18252.10, juvenile correctional facilities as defined in s. 938.02 (10p), correctional
19institutions governed by the department of corrections under s. 301.02, and the
20offices and clinics of persons licensed to treat the sick under chs. 446, 447, and 448
21are exempt from ss. 50.32 to 50.39. Sections 50.32 to 50.39 do not abridge the rights
22of the medical examining board,
physician assistant examining board, physical
23therapy examining board, podiatry affiliated credentialing board, dentistry
24examining board, pharmacy examining board, chiropractic examining board, and
25board of nursing in carrying out their statutory duties and responsibilities.
SB515,12
1Section
12. 50.60 (1) of the statutes is amended to read:
SB515,6,32
50.60
(1) “Health care provider" has the meaning given in s. 146.81 (1) (a) to
3(hp) (hr).
SB515,13
4Section 13
. 55.14 (8) (b) of the statutes is amended to read:
SB515,6,155
55.14
(8) (b) Order the individual to comply with the treatment plan under par.
6(a). The order shall provide that if the individual fails to comply with provisions of
7the treatment plan that require the individual to take psychotropic medications, the
8medications may be administered involuntarily with consent of the guardian. The
9order shall specify the methods of involuntary administration of psychotropic
10medication to which the guardian may consent. An order authorizing the forcible
11restraint of an individual shall specify that a person licensed under s. 441.06, 441.10,
12or 448.05 (2)
or (5), or 461.07 shall be present at all times that psychotropic
13medication is administered in this manner and shall require the person or facility
14using forcible restraint to maintain records stating the date of each administration,
15the medication administered, and the method of forcible restraint utilized.
SB515,14
16Section 14
. 69.01 (6g) of the statutes is amended to read:
SB515,6,1917
69.01
(6g) “Date of death" means the date that a person is pronounced dead by
18a physician, coroner, deputy coroner, medical examiner, deputy medical examiner,
19physician assistant, or hospice nurse.
SB515,15
20Section 15
. 69.18 (1) (ck) of the statutes is created to read:
SB515,6,2421
69.18
(1) (ck) For purposes of preparation of the certificate of death and in
22accordance with accepted medical standards, a physician assistant who is directly
23involved with the care of a patient who dies may pronounce the date, time, and place
24of the patient's death.
SB515,16
25Section
16. 70.47 (8) (intro.) of the statutes is amended to read:
SB515,7,13
170.47
(8) Hearing. (intro.) The board shall hear upon oath all persons who
2appear before it in relation to the assessment. Instead of appearing in person at the
3hearing, the board may allow the property owner, or the property owner's
4representative, at the request of either person, to appear before the board, under
5oath, by telephone or to submit written statements, under oath, to the board. The
6board shall hear upon oath, by telephone, all ill or disabled persons who present to
7the board a letter from a physician
, osteopath, physician assistant,
as defined in s.
8448.01 (6), or advanced practice nurse prescriber certified under s. 441.16 (2) that
9confirms their illness or disability. At the request of the property owner or the
10property owner's representative, the board may postpone and reschedule a hearing
11under this subsection, but may not postpone and reschedule a hearing more than
12once during the same session for the same property. The board at such hearing shall
13proceed as follows:
SB515,17
14Section
17. 97.67 (5m) (a) 3. of the statutes is amended to read:
SB515,7,1515
97.67
(5m) (a) 3. A physician assistant licensed under
subch. II of ch.
448
461.
SB515,18
16Section
18. 118.2925 (1) (f) of the statutes is amended to read:
SB515,7,1817
118.2925
(1) (f) “Physician assistant" means a person licensed under s.
448.04
18(1) (f) 461.07.
SB515,19
19Section
19. 146.38 (1) (b) 1. of the statutes is amended to read:
SB515,7,2020
146.38
(1) (b) 1. A person specified in s. 146.81 (1) (a) to
(hp) (hr), (r), or (s).
SB515,20
21Section
20. 146.81 (1) (d) of the statutes is amended to read:
SB515,7,2322
146.81
(1) (d) A physician,
physician assistant, perfusionist, or respiratory care
23practitioner licensed or certified under subch. II of ch. 448.
SB515,21
24Section
21. 146.81 (1) (hr) of the statutes is created to read:
SB515,7,2525
146.81
(1) (hr) A physician assistant licensed under ch. 461.
SB515,22
1Section
22. 146.81 (1) (i) of the statutes is amended to read:
SB515,8,32
146.81
(1) (i) A partnership of any providers specified under pars. (a) to
(hp) 3(hr).
SB515,23
4Section
23. 146.81 (1) (j) of the statutes is amended to read:
SB515,8,65
146.81
(1) (j) A corporation or limited liability company of any providers
6specified under pars. (a) to
(hp) (hr) that provides health care services.
SB515,24
7Section
24. 146.82 (3) (a) of the statutes is amended to read: