LRB-0656/1
JPC:kjf
2021 - 2022 LEGISLATURE
March 9, 2021 - Introduced by Senators Bernier, Ballweg, Bewley, Carpenter,
Cowles, Darling, Felzkowski, Jacque, Kooyenga, Pfaff, Ringhand,
Stafsholt, Smith, Testin and Wimberger, cosponsored by Representatives
VanderMeer, Anderson, Andraca, Armstrong, Baldeh, Considine, Dittrich,
Doyle, Edming, Gundrum, Hong, James, Kerkman, Krug, Loudenbeck,
Magnafici, Milroy, Moses, Mursau, Oldenburg, Ramthun, S. Rodriguez,
Rozar, Sinicki, Skowronski, Spiros, Steffen, Stubbs, Summerfield,
Tauchen, Tittl, Thiesfeldt, Vruwink and Spreitzer. Referred to Committee
on Health.
SB184,2,6
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) and 450.01
3(15r);
to renumber 448.970, subchapter VIII of chapter 448 [precedes 448.980]
4and subchapter IX of chapter 448 [precedes 448.985];
to amend 15.08 (1m) (b),
515.085 (1m) (b), 16.417 (1) (e) 3m., 46.03 (44), 48.981 (2m) (b) 1., 49.45 (9r) (a)
67. a., 50.08 (2), 50.39 (3), 55.14 (8) (b), 69.01 (6g), 70.47 (8) (intro.), 97.67 (5m)
7(a) 3., 118.2925 (1) (f), 146.81 (1) (d), 146.82 (3) (a), 146.89 (1) (r) 1., 146.997 (1)
8(d) 5., 154.01 (3) (intro.), 154.03 (2), 154.07 (1) (a) (intro.), 165.77 (1) (a), 255.07
9(1) (d), 343.16 (5) (a), 440.035 (2m) (b), 440.035 (2m) (c) 1. (intro.), 448.015 (4)
10(am) 2., 448.02 (1), 448.03 (2) (a), 448.03 (2) (e), 448.03 (2) (k), 448.03 (5) (b),
11448.035 (2) to (4), 448.037 (2) (a) (intro.) and (b) and (3), 448.62 (7), 448.695 (4)
12(a) and (b), 450.01 (16) (hm) 3., 450.11 (1), 450.11 (1g) (b), 450.11 (1i) (a) 1.,
13450.11 (1i) (b) 2. c., 450.11 (1i) (c) 2., 450.11 (8) (b), 462.02 (2) (e), 462.04, 961.01
14(19) (a) and 971.14 (4) (a); and
to create 15.406 (7), 49.45 (9r) (a) 7. e., 69.18 (1)
1(ck), 146.81 (1) (eu), subchapter VIII of chapter 448 [precedes 448.971], 450.11
2(1i) (b) 2. cm., 450.11 (8) (f) and 990.01 (27s) of the statutes;
relating to:
3regulation of physician assistants, creating a Physician Assistant Affiliated
4Credentialing Board, extending the time limit for emergency rule procedures,
5providing an exemption from emergency rule procedures, granting
6rule-making authority, and 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. However, the Podiatry Affiliated Credentialing Board has the
authority to establish practice standards for PAs practicing under podiatrists.
This bill creates the Physician Assistant Affiliated Credentialing Board
attached to the Medical Examining Board. The new board is composed of eight PAs
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 PA's employment, there is a physician who is primarily responsible
for the overall direction and management of the PA's professional activities and for
assuring that the services provided by the PA are medically appropriate or 2) a
written collaborative agreement with a physician that 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. The bill maintains the current requirements for PAs
practicing under podiatrists and the authority of the Podiatry Affiliated
Credentialing Board to establish practice standards for PAs practicing under
podiatrists.
2. Defines a PA's practice similarly to the definition of the practice of medicine
and surgery for purposes of physician licensure under current law. 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 current law 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:
SB184,1
1Section 1
. 15.08 (1m) (b) of the statutes is amended to read:
SB184,3,112
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 physician assistants, the board of nursing, the nursing home administrator
7examining board, the veterinary examining board, the optometry examining board,
8the pharmacy examining board, the marriage and family therapy, professional
9counseling, and social work examining board, the psychology examining board, and
10the radiography examining board shall not be engaged in any profession or
11occupation concerned with the delivery of physical or mental health care.
SB184,2
12Section 2
. 15.085 (1m) (b) of the statutes is amended to read:
SB184,4,5
115.085
(1m) (b) The public members of the podiatry affiliated credentialing
2board
or, the occupational therapists affiliated credentialing board
, and the
3physician assistant affiliated credentialing board shall not be engaged in any
4profession or occupation concerned with the delivery of physical or mental health
5care.
SB184,3
6Section 3
. 15.406 (7) of the statutes is created to read:
SB184,4,107
15.406 (7)
Physician assistant affiliated credentialing board. There is
8created in the department of safety and professional services, attached to the medical
9examining board, a physician assistant affiliated credentialing board consisting of
10the following members appointed for staggered 4-year terms:
SB184,4,1111
(a) Eight physician assistants licensed under subch. VIII of ch. 448.
SB184,4,1212
(b) One public member.
SB184,4
13Section 4
. 15.407 (2) of the statutes is repealed.
SB184,5
14Section 5
. 16.417 (1) (e) 3m. of the statutes is amended to read:
SB184,4,1615
16.417
(1) (e) 3m. A physician assistant who is licensed under s.
448.04 (1) (f) 16448.974.
SB184,6
17Section 6
. 46.03 (44) of the statutes is amended to read:
SB184,5,218
46.03
(44) Sexually transmitted disease treatment information. Prepare and
19keep current an information sheet to be distributed to a patient by a physician,
20physician assistant, or certified advanced practice nurse prescriber providing
21expedited partner therapy to that patient under s. 448.035
or 448.9725. The
22information sheet shall include information about sexually transmitted diseases and
23their treatment and about the risk of drug allergies. The information sheet shall also
24include a statement advising a person with questions about the information to
1contact his or her physician, pharmacist, or local health department, as defined in
2s. 250.01 (4).
SB184,7
3Section 7
. 48.981 (2m) (b) 1. of the statutes is amended to read:
SB184,5,64
48.981
(2m) (b) 1. “Health care provider" means a physician, as defined under
5s. 448.01 (5), a physician assistant, as defined under s.
448.01 (6) 448.971 (2), or a
6nurse holding a license under s. 441.06 (1) or a license under s. 441.10.
SB184,8
7Section 8
. 49.45 (9r) (a) 7. a. of the statutes is amended to read:
SB184,5,98
49.45
(9r) (a) 7. a. A physician
or physician assistant licensed under subch. II
9of ch. 448.
SB184,9
10Section 9
. 49.45 (9r) (a) 7. e. of the statutes is created to read:
SB184,5,1111
49.45
(9r) (a) 7. e. A physician assistant licensed under subch. VIII of ch. 448.
SB184,10
12Section 10
. 50.01 (4p) of the statutes is repealed.
SB184,11
13Section 11
. 50.08 (2) of the statutes is amended to read:
SB184,5,1814
50.08
(2) A physician, an advanced practice nurse prescriber certified under
15s. 441.16 (2), or a physician assistant
licensed under ch. 448, who prescribes a
16psychotropic medication to a nursing home resident who has degenerative brain
17disorder shall notify the nursing home if the prescribed medication has a boxed
18warning under
21 CFR 201.57.
SB184,12
19Section 12
. 50.39 (3) of the statutes is amended to read:
SB184,6,320
50.39
(3) Facilities governed by ss. 45.50, 48.62, 49.70, 49.72, 50.02, 51.09, and
21252.10, juvenile correctional facilities as defined in s. 938.02 (10p), correctional
22institutions governed by the department of corrections under s. 301.02, and the
23offices and clinics of persons licensed to treat the sick under chs. 446, 447, and 448
24are exempt from ss. 50.32 to 50.39. Sections 50.32 to 50.39 do not abridge the rights
25of the medical examining board,
physician assistant affiliated credentialing board,
1physical therapy examining board, podiatry affiliated credentialing board, dentistry
2examining board, pharmacy examining board, chiropractic examining board, and
3board of nursing in carrying out their statutory duties and responsibilities.
SB184,13
4Section 13
. 55.14 (8) (b) of the statutes is amended to read:
SB184,6,155
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 448.974 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.
SB184,14
16Section 14
. 69.01 (6g) of the statutes is amended to read:
SB184,6,1917
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.
SB184,15
20Section 15
. 69.18 (1) (ck) of the statutes is created to read:
SB184,6,2421
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.
SB184,16
25Section 16
. 70.47 (8) (intro.) of the statutes is amended to read:
SB184,7,13
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:
SB184,17
14Section 17
. 97.67 (5m) (a) 3. of the statutes is amended to read:
SB184,7,1515
97.67
(5m) (a) 3. A physician assistant licensed under subch.
II VIII of ch. 448.
SB184,18
16Section 18
. 118.2925 (1) (f) of the statutes is amended to read:
SB184,7,1817
118.2925
(1) (f) “Physician assistant" means a person licensed under s.
448.04
18(1) (f) 448.974.
SB184,19
19Section 19
. 146.81 (1) (d) of the statutes is amended to read:
SB184,7,2120
146.81
(1) (d) A physician,
physician assistant, perfusionist, or respiratory care
21practitioner licensed or certified under subch. II of ch. 448.
SB184,20
22Section 20
. 146.81 (1) (eu) of the statutes is created to read:
SB184,7,2323
146.81
(1) (eu) A physician assistant licensed under subch. VIII of ch. 448.
SB184,21
24Section 21
. 146.82 (3) (a) of the statutes is amended to read:
SB184,8,7
1146.82
(3) (a) Notwithstanding sub. (1), a physician,
a physician assistant,
as
2defined in s. 448.01 (6), or
an advanced practice nurse prescriber certified under s.
3441.16 (2) who treats a patient whose physical or mental condition in the physician's,
4physician assistant's, or advanced practice nurse prescriber's judgment affects the
5patient's ability to exercise reasonable and ordinary control over a motor vehicle may
6report the patient's name and other information relevant to the condition to the
7department of transportation without the informed consent of the patient.
SB184,22
8Section 22
. 146.89 (1) (r) 1. of the statutes is amended to read:
SB184,8,139
146.89
(1) (r) 1. Licensed as a physician under ch. 448, a dentist or dental
10hygienist under ch. 447, a registered nurse, practical nurse, or nurse-midwife under
11ch. 441, an optometrist under ch. 449, a physician assistant under
subch. VIII of ch.
12448, a pharmacist under ch. 450, a chiropractor under ch. 446, a podiatrist under
13subch. IV of ch. 448, or a physical therapist under subch. III of ch. 448.
SB184,23
14Section 23
. 146.997 (1) (d) 5. of the statutes is amended to read:
SB184,8,1715
146.997
(1) (d) 5. An occupational therapist, occupational therapy assistant,
16physician assistant or respiratory care practitioner
licensed or certified under ch.
17448.
SB184,24
18Section 24
. 154.01 (3) (intro.) of the statutes is amended to read:
SB184,8,2019
154.01
(3) (intro.) “Health care professional" means
who is, or who holds a
20compact privilege under subch. IX of ch. 448 any of the following:
SB184,25
21Section 25
. 154.03 (2) of the statutes is amended to read:
SB184,9,1422
154.03
(2) The department shall prepare and provide copies of the declaration
23and accompanying information for distribution in quantities to persons licensed,
24certified, or registered under ch. 441, 448, or 455, persons who hold a compact
25privilege under subch.
IX X of ch. 448, hospitals, nursing homes, county clerks and
1local bar associations and individually to private persons. The department shall
2include, in information accompanying the declaration, at least the statutory
3definitions of terms used in the declaration, statutory restrictions on who may be
4witnesses to a valid declaration, a statement explaining that valid witnesses acting
5in good faith are statutorily immune from civil or criminal liability, an instruction
6to potential declarants to read and understand the information before completing the
7declaration and a statement explaining that an instrument may, but need not be,
8filed with the register in probate of the declarant's county of residence. The
9department may charge a reasonable fee for the cost of preparation and distribution.
10The declaration distributed by the department of health services shall be easy to
11read, the type size may be no smaller than 10 point, and the declaration shall be in
12the following form, setting forth on the first page the wording before the
13ATTENTION statement and setting forth on the 2nd page the ATTENTION
14statement and remaining wording:
SB184,9,15
15Declaration to health care professionals
SB184,9,1616
(WISCONSIN LIVING WILL)