Tammi Kuhl, Services Section
Office of the Commissioner of Insurance
Telephone (608) 266-0110
or at:
121 East Wilson Street
P.O. Box 7873
Madison, WI 53707-7873
Notice of Hearing
Medical Examining Board
Notice is hereby given that pursuant to authority vested in the Medical Examining Board in ss. 15.08 (5) (b ) and 227.11 (2), Stats., and s. 448.05 (5) (a) (intro.), Stats., as amended by 1997 Wisconsin Act 67, and interpreting ss. 448.01 (6), 448.02 (1), 448.03 (1) (b), (e) and (3) (e), 448.04 (1) (f), 448.05 (5), 448.20 (1), (3) (a), 448.21 and 448.40 (2) (f), Stats., the Medical Examining Board will hold a public hearing at the time and place indicated below to consider an order to repeal Med 8.05 (2) (b) 10. and 11.; to renumber and amend Med 8.02 (3); to amend Med 8.01, 8.02 (6), 8.03, 8.04, 8.05, (1) (intro.), the Note following 8.05 (1) (a), and (cm), (2) (b) 5., (c) and (d), (4) (title) and (4), 8.06 (title), (1) (intro.), (b), (c), (2) (a), (b) and (3), 8.07 (1), (2) (title), (2) (intro.), (c), (e), (f) and (i), 8.08 (title), (1), (2) (intro.), (a), (b), (c), (d), (e) 2. and 3. and 8.10 (1); and to create Med 8.06 (4), relating to licensure and regulation of physician assistants.
Hearing Information
March 25, 1999 1400 E. Washington Ave.
Monday Room 179A
9:00 a.m. Madison, WI
Appearances at the Hearing
Interested persons are invited to present information at the hearing. Persons appearing may make an oral presentation but are urged to submit facts, opinions and argument in writing as well. Facts, opinions and argument may also be submitted in writing without a personal appearance by mail addressed to the Department of Regulation and Licensing, Office of Administrative Rules, P.O. Box 8935, Madison, Wisconsin 53708. Written comments must be received by March 10, 1999 to be included in the record of rule-making proceedings.
Analysis prepared by the Department of Regulation and Licensing
Statutes authorizing promulgation: ss. 15.08 (5) (b)
and 227.11 (2), Stats., and s. 448.05 (5) (a) (intro.),
as amended by 1997 Wis. Act 67
Statutes interpreted: ss. 448.01 (6), 448.02 (1), 448.03
(1) (b), (2) (e) and (3) (e), 448.04(1) (f), 448.05 (5),
448.20 (1), (3) (a), 448.21 and 448.40 (2) (f)
This proposed rule-making order of the Medical Examining Board amends chapter Med 8 as required by 1997 Wisconsin Act 67.
The new law required that the board promulgate rules specifying changing the terms “patient services" to “medical care"; changing the credentialing title from “certification" to “licensure"; and changing the prescribing limitations from “protocols" to “guidelines." These proposed rules also make form and clarity changes to which questions have arisen and the board feels might best be clarified by minor changes to the rules.
Text of Rule
SECTION 1. Med 8.01 is amended to read:
Med 8.01 Authority and purpose. The rules in this chapter are adopted by the medical examining board pursuant to authority in ss. 15.08 (5) (b), 227.11, 448.04 (1) (f) and 448.40, Stats., and govern the certification licensure and regulation of physician assistants.
SECTION 2. Med 8.02 (3) is renumbered Med 8.02 (5m) and amended to read:
Med 8.02 (5m) “Certificate" “
License" means documentary evidence issued by the board to applicants for certification licensure as a physician assistant who meet all of the requirements of the board.
SECTION 3. Med 8.02 (6) is amended to read:
Med 8.02 (6) “Supervision" means to coordinate, direct, and inspect continually the accomplishments of another, or to oversee with powers of direction and decision the implementation of one's own or another's intentions.
SECTION 4. Med 8.03 and 8.04 are amended to read:
Med 8.03 Council. As specified in s. 15.407 (1) and (2), Stats., the council shall advise the board on the formulation of rules on the education, examination, certification licensure and practice of a physician assistant.
Med 8.04 Educational program approval. The board shall approve only educational programs accredited and approved by the committee on allied health education and accreditation of the American medical association, the commission for accreditation of allied health education programs, or its successor agency.
SECTION 5. Med 8.05, (1) (intro.), the Note following (1) (a), and (cm) are amended to read:
Med 8.05 Panel review of applications; examinations required. The board may use a written examination prepared, administered and scored by the national commission on certification of physician assistants or its successor agency, or a written examination from other professional testing services as approved by the board.
(1) APPLICATION. (intro.) An applicant for examination for certification licensure as a physician assistant shall submit to the board:
Note: An application form may be obtained upon request to the Medical Examining Board located at Room 176, 1400 East Washington Avenue, P.O. Box 8935, Madison, Wisconsin 53702 53708.
(cm) Proof that the applicant is currently certified to assist primary care physicians by the national commission on certification of physician assistants or its successor agency.
SECTION 6. Med 8.05 (2) (b) 5. is amended to read:
Med 8.05 (2) (b) 5. Has not practiced patient care as a physician assistant for a period of 3 years prior to application, unless the applicant has been graduated from a school approved an approved educational program for physician assistants within that period.
SECTION 7. Med 8.05 (2) (b) 10. and 11. are repealed.
SECTION 8. Med 8.05 (2) (c) and (d) are amended to read:
Med 8.05 (2) (c) An application filed under this chapter shall be reviewed by an application review panel of at least 2 council members designated by the chairperson of the board to determine whether an applicant is required to complete an oral examination under par. (a). If the application review panel is not able to reach unanimous agreement on whether an applicant is eligible for certification licensure without completing an oral examination, the application shall be referred to the board for a final determination.
(d) Where both written and oral examinations are required they shall be scored separately and the applicant shall achieve a passing grade on both examinations to qualify for a certificate license.
SECTION 9. Med 8.05 (4) (title) and (4) are amended to read:
Med 8.05 (4) (title) CERTIFICATION LICENSURE; RENEWAL. At the time of certification licensure and each biennial registration of certification licensure thereafter, a physician assistant shall list with the board the name and address of the supervising physician and shall notify the board within 20 days of any change of a supervising physician.
SECTION 10. Med 8.06 (title), (1) (intro.), (b), (c), (2) (a), (b) and (3) are amended to read:
Med 8.06 (title) Temporary certificate license. (1) (intro.) An applicant` for certification licensure may apply to the board for a temporary certificate license to practice as a physician assistant if the applicant:
(b) Is a graduate of an approved school and is scheduled to take the examination for primary care physician's
physician assistants required by s. Med 8.05 (1) or has taken the examination and is awaiting the results; or
(c) Submits proof of successful completion of the examination required by s. Med 8.05 (1) and applies for a temporary certificate license no later than 30 days prior to the date scheduled for the next oral examination.
(2) (a) Except as specified in par. (b), a temporary certificate license expires on the date the board grants or denies an applicant permanent certification licensure. Permanent certification licensure to practice as a physician assistant is deemed denied by the board on the date the applicant is sent notice from the board that he or she has failed the examination required by s. Med 8.05 (1) (c).
(b) A temporary certificate license expires on the first day of the next regularly scheduled oral examination for permanent certification licensure if the applicant is required to take, but failed to apply for, the examination.
(3) A temporary permit license may not be renewed.
SECTION 11. Med 8.06 (4) is created to read:
Med 8.06 (4) An applicant holding a temporary license may apply for one transfer of supervising physician and location during the term of the temporary license.
SECTION 12. Med 8.07 (1), (2) (title), (2) (intro.), (c), (e), (f) and (i) are amended to read:
Med 8.07 (1) SCOPE AND LIMITATIONS. In providing patient services medical care, the entire practice of any physician assistant shall be under the supervision of a licensed physician. The scope of practice is limited to providing patient services
medical care specified in sub. (2). A physician assistant's practice may not exceed the scope of practice of the supervising physician. A
medical care task assigned by the supervising physician to a physician assistant may not be delegated by the physician assistant to another person.
(2) (title) PATIENT SERVICES MEDICAL CARE. (intro.) Patient services Medical care a physician assistant may provide include includes:
(c) Performing routine therapeutic procedures, including, but not limited to, injections, immunizations, and the suturing and care of wounds.
(e) Assisting the supervising physician in a hospital or facility, as defined in s. 50.01 (1m), Stats., by assisting in surgery, making patient rounds, recording patient progress notes, compiling and recording detailed narrative case summaries and accurately writing or executing standing orders or other specific orders following consultation with and at the direction of the supervising
under the supervision of a licensed physician.
(f) Assisting in the delivery of services
medical care to a patient by reviewing and monitoring treatment and therapy plans.
(i) Preparing Issuing written prescription orders for drugs if specifically directed to do so by the supervising under the supervision of a licensed physician and in accordance with procedures specified in s. Med 8.08 (2).
SECTION 13. Med 8.08 (title), (1), (2) (intro.), (a), (b), (c), (d), (e) 2. and 3. are amended to read:
Med 8.08 (title) Prohibitions and
Prescribing limitations. (1) ACUPUNCTURE AND INDEPENDENT PRESCRIBING PROHIBITED. A physician assistant may not practice acupuncture in any form and may not prescribe or dispense any drug independently. A supervising physician may direct a physician assistant to prepare a prescription order according to procedures specified in sub. (2).
(2) PRESCRIBING LIMITATIONS. (intro.) A physician assistant may prepare issue a prescription order only if all of the following conditions apply:
(a) The physician assistant prepares issues the prescription order only in patient situations specified and described established written protocols guidelines. The
protocol guidelines shall be reviewed at least annually by the physician assistant and his or her supervising physician.
(b) The supervising physician and physician assistant determine by mutual agreement that the physician assistant is qualified through training and experience to prepare issue a prescription order as specified in the established written protocols
guidelines.
(c) When practicable, the physician assistant consults directly with the supervising physician prior to preparing a prescription order. In any case the The supervising physician shall be is available for consultation as specified in s. Med 8.10 (2)
(3).
(d) The prescription orders prepared under procedures in this section contain, in addition to other information required by law, the name, address and telephone number of the supervising physician
, the DEA registration number of the supervising physician if the prescription is prepared for a controlled substance, the name and address of the physician assistant, legibly printed, the DEA registration number of the physician assistant if the prescription is prepared for a controlled substance and if the physician assistant is registered with DEA, and the signature of the physician assistant.
(e) 2. Reviews and countersigns within one day
72 hours the patient record prepared by the physician assistant practicing in the office of the supervising physician or at a facility or a hospital in which the supervising physician has staff privileges; or
3. Reviews by telephone or other means, as soon as practicable but within a 48-hour 72-hour period, and countersigns within one week, the patient record prepared by the physician assistant who practices in an office facility other than the supervising physician's main office of a facility or hospital in which the supervising physician has staff privileges.
SECTION 14. Med 8.10 (1) is amended to read:
Med 8.10 (1) No physician may concurrently supervise more than 2 physician assistants unless the physician submits a written plan for the supervision of more than 2 physician assistants and the board approves the plan. A physician assistant may be supervised by more than one physician.
Fiscal Estimate
1. The anticipated fiscal effect on the fiscal liability and revenues of any local unit of government of the proposed rule is: $0.00.
2. The projected anticipated state fiscal effect during the current biennium of the proposed rule is: $0.00.
3. The projected net annualized fiscal impact on state funds of the proposed rule is: $0.00.
Initial Regulatory Flexibility Analysis
These proposed rules will be reviewed by the department through its Small Business Review Advisory Committee to determine whether there will be an economic impact on a substantial number of small businesses, as defined in s. 227.114 (1) (a), Stats.
Copies of Rule and Contact Person
Copies of this proposed rule are available without cost upon request to: Pamela Haack, Department of Regulation and Licensing, Office of Administrative Rules, 1400 East Washington Avenue, Room 171, P.O. Box 8935, Madison, Wisconsin 53708 (608) 266-0495.
Notice of Hearing
Revenue
Notice is hereby given that pursuant to s. 227.11 (2) (a), Stats., and interpreting s. 77.54 (9a), Stats., s. 77.51 (18) and (22) (a), Stats., as amended by 1997 Wis. Act 27 and s. 77.54 (43), Stats., as created by 1997 Wis. Act 27, the Department of Revenue will hold a public hearing at the time and place indicated below, to consider the amendment of rules relating to printed material exemptions and the sales and use tax treatment of advertising agencies.
Hearing Information
