2017 WISCONSIN ACT 227
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.
The people of the state of Wisconsin, represented in senate and assembly, do enact as follows:
227,1
Section
1. 441.16 (6) of the statutes is amended to read:
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.
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2. 448.01 (6) of the statutes is amended to read:
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.
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3. 448.015 (1u) of the statutes is created to read:
448.015 (1u) “Podiatrist" has the meaning given in s. 448.60 (3).
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4. 448.015 (1w) of the statutes is created to read:
448.015 (1w) “Podiatry" has the meaning given in s. 448.60 (4).
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5. 448.05 (5) (a) (intro.) of the statutes is renumbered 448.05 (5) (a) and amended to read:
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.
(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:
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6. 448.05 (5) (a) 1. and 2. of the statutes are renumbered 448.05 (5) (b) 1. and 2.
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7. 448.20 (1) of the statutes is amended to read:
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.
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8. 448.20 (3m) of the statutes is created to read:
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.
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9. 448.21 (1) (d) of the statutes is amended to read:
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).
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10. 448.21 (2) of the statutes is amended to read:
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.
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11. 448.21 (3) of the statutes is amended to read:
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.
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12. 448.21 (4) of the statutes is created to read:
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.
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13. 448.62 (2m) of the statutes is created to read:
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.
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14. 448.62 (7) of the statutes is created to read:
448.62 (7) A physician assistant who is acting under the supervision and direction of a podiatrist, subject to s. 448.21 (4).
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15. 448.695 (4) of the statutes is created to read:
448.695 (4) The affiliated credentialing board shall promulgate rules establishing all of the following:
(a) Practice standards for a physician assistant practicing podiatry as provided in s. 448.21 (4).
(b) Requirements for a podiatrist who is supervising a physician assistant as provided in s. 448.21 (4).
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16. Med 8.01 (2) of the statutes is amended to read:
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.
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17. Med 8.02 (5x) of the administrative code is created to read:
Med 8.02 (5x) “Podiatrist” has the meaning given in s. 448.60 (3), Stats.
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18. Med 8.05 (4) of the administrative code is amended to read:
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.
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19. Med 8.07 (1), (2) (i) and (3) of the administrative code are amended to read:
Med 8.07 (1) Scope and limitations. In providing medical care, the entire practice of any physician assistant shall be under the supervision of one or more licensed physicians or, physicians exempt from licensure requirements pursuant to s. 448.03 (2) (b), Stats., or licensed podiatrists. The scope of practice is limited to providing medical care as specified in sub. (2). A physician assistant's practice may not exceed his or her educational training or experience and may not exceed the scope of practice of the physician or podiatrist providing supervision. A medical care task assigned by the supervising physician or podiatrist to a physician assistant may not be delegated by the physician assistant to another person.
(2) (i) Issuing written prescription orders for drugs provided the physician assistant has had an initial and at least annual thereafter, review of the physician assistant's prescriptive practices by a physician or podiatrist providing supervision. Such reviews shall be documented in writing, signed by the reviewing physician or podiatrist and by the physician assistant, and made available to the Board for inspection upon reasonable request.
(3) Identifying supervising physician or podiatrist. The physician or podiatrist providing supervision must be readily identifiable by the physician assistant through procedures commonly employed in the physician assistant's practice.
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Section
20. Med 8.09 of the administrative code is amended to read:
Med 8.09 Employee status. No physician assistant may be self-employed. If the employer of a physician assistant is other than a licensed physician or podiatrist, the employer shall provide for, and may not interfere with, the supervisory responsibilities of the physician or podiatrist, as defined in s. Med 8.02 (6) and required in ss. Med 8.07 (1) and 8.10.
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21. Med 8.10 of the administrative code is amended to read:
Med 8.10 Physician or podiatrist to physician assistant ratio. (1) No physician or podiatrist may supervise more than 4 on-duty physician assistants at any time unless a written plan to do so has been submitted to and approved by the board. Nothing herein shall limit the number of physician assistants for whom a physician or podiatrist may provide supervision over time. A physician assistant may be supervised by more than one physician or podiatrist while on duty.
(2) A supervising physician or podiatrist shall be available to the physician assistant at all times for consultation either in person or within 15 minutes of contact by telecommunication or other means.
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22.
Nonstatutory provisions.
(1) Emergency rules. Using the procedure under section 227.24 of the statutes, the podiatry affiliated credentialing board may promulgate emergency rules under section 448.695 (4) of the statutes. Notwithstanding section 227.24 (1) (a), (2) (b), and (3) of the statutes, the board is not required to provide evidence that promulgating rules under this subsection as emergency rules is necessary for the preservation of the public peace, health, safety, or welfare and is not required to provide a finding of emergency for rules promulgated under this subsection.
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23.
Effective dates. This act takes effect on the day after publication, except as follows:
(1) The modifications of administrative rules take effect as provided in section 227.265 of the statutes.
