SB515: Bill Text

SB515,19,11 Physician assistants

SB515,19,12 461.01 Definitions. In this chapter, unless the context requires otherwise:

SB515,19,13 (1) “Board" means the physician assistant examining board.

SB515,19,16 (2) “Disease” means any pain, injury, deformity, or physical or mental illness or departure from complete health or the proper condition of the human body or any of its parts.

SB515,19,17 (3) “Physician assistant” means a person licensed under this chapter.

SB515,19,18 (4) “Podiatrist” has the meaning given in s. 448.60 (3).

SB515,19,19 (5) “Podiatry” has the meaning given in s. 448.60 (4).

SB515,19,20 (6) “Practice of medicine and surgery” has the meaning given in s. 448.01 (9).

SB515,20,3 461.03 License required; exceptions. (1) Except as provided in subs. (2) and (3), no person may represent himself or herself as a “PA,” “ physician assistant," “physician associate,” or “associate physician,” use or assume the title “PA,” “physician assistant," “physician associate,” or “associate physician,” or append to the person's name the words or letters “physician assistant," “physician associate,” “associate physician,” “PA," “PA-C,” or any other titles, letters, or designation that represents or may tend to represent the person as a physician assistant, unless he or she is licensed by the board under this chapter.

SB515,20,4 (2) Subsection (1) does not apply with respect to any of the following:

SB515,20,8 (a) An individual employed and duly credentialed as a physician assistant or physician associate by the federal government while performing duties incident to that employment, unless a license under this chapter is required by the federal government.

SB515,20,12 (b) A person who satisfies the requirement under s. 461.07 (1) (a) 3. but who is not licensed under this chapter. This paragraph does not allow such a person to practice medicine and surgery in violation of s. 448.03 (1) (a) or to practice podiatry in violation of s. 448.61.

SB515,20,14 (3) A student who is enrolled in an accredited physician assistant educational program may use the title “physician assistant student,” “PA student,” or “PA-S.”

SB515,20,15 461.035 Expedited partner therapy. (1) In this section:

SB515,20,16 (b) “Antimicrobial drug" has the meaning given in s. 448.035 (1) (b).

SB515,20,17 (c) “Expedited partner therapy" has the meaning given in s. 448.035 (1) (c).

SB515,21,3 (2) Notwithstanding the requirements of s. 461.40, a physician assistant may provide expedited partner therapy if a patient is diagnosed as infected with a chlamydial infection, gonorrhea, or trichomoniasis and the patient has had sexual contact with a sexual partner during which the chlamydial infection, gonorrhea, or trichomoniasis may have been transmitted to or from the sexual partner. The physician assistant shall attempt to obtain the name of the patient's sexual partner. A prescription order for an antimicrobial drug prepared under this subsection shall include the name and address of the patient's sexual partner, if known. If the physician assistant is unable to obtain the name of the patient's sexual partner, the prescription order shall include, in ordinary, bold-faced capital letters, the words, “expedited partner therapy" or the letters “EPT."

SB515,21,7 (3) The physician assistant shall provide the patient with a copy of the information sheet prepared by the department of health services under s. 46.03 (44) and shall request that the patient give the information sheet to the person with whom the patient had sexual contact.

SB515,21,11 (4) (a) Except as provided in par. (b), a physician assistant is immune from civil liability for injury to or the death of a person who takes any antimicrobial drug if the antimicrobial drug is prescribed, dispensed, or furnished under this section and if expedited partner therapy is provided as specified under this section.

SB515,21,14 (b) The immunity under par. (a) does not extend to the donation, distribution, furnishing, or dispensing of an antimicrobial drug by a physician assistant whose act or omission involves reckless, wanton, or intentional misconduct.

SB515,21,16 461.037 Prescriptions for and delivery of opioid antagonists. (1) In this section:

SB515,21,17 (a) “Administer" has the meaning given in s. 450.01 (1).

SB515,21,18 (b) “Deliver" has the meaning given in s. 450.01 (5).

SB515,21,19 (c) “Dispense" has the meaning given in s. 450.01 (7).

SB515,21,20 (d) “Opioid antagonist" has the meaning given in s. 450.01 (13v).

SB515,21,21 (e) “Opioid-related drug overdose" has the meaning given in s. 256.40 (1) (d).

SB515,21,22 (f) “Standing order" has the meaning given in s. 450.01 (21p).

SB515,21,23 (2) (a) A physician assistant may do any of the following:

SB515,22,4 1. Prescribe an opioid antagonist to a person in a position to assist an individual at risk of undergoing an opioid-related drug overdose and may deliver the opioid antagonist to that person. A prescription order under this subdivision need not specify the name and address of the individual to whom the opioid antagonist will be administered, but shall instead specify the name of the person to whom the opioid antagonist is prescribed.

SB515,22,6 2. Issue a standing order to one or more persons authorizing the dispensing of an opioid antagonist.

SB515,22,13 (b) A physician assistant who prescribes or delivers an opioid antagonist under par. (a) 1. shall ensure that the person to whom the opioid antagonist is prescribed has or has the capacity to provide the knowledge and training necessary to safely administer the opioid antagonist to an individual undergoing an opioid-related overdose and that the person demonstrates the capacity to ensure that any individual to whom the person further delivers the opioid antagonist has or receives that knowledge and training.

SB515,22,19 (3) A physician assistant who, acting in good faith, prescribes or delivers an opioid antagonist in accordance with sub. (2) or who, acting in good faith, otherwise lawfully prescribes or dispenses an opioid antagonist shall be immune from criminal or civil liability and may not be subject to professional discipline under s. 461.30 for any outcomes resulting from prescribing, delivering, or dispensing the opioid antagonist.

SB515,22,21 461.05 Powers and duties of board. (1) (a) The board shall promulgate rules implementing s. 461.40.

SB515,22,23 (b) The board shall promulgate rules establishing continuing education requirements for physician assistants.

SB515,22,25 (c) The board may promulgate other rules to carry out the purposes of this chapter, including any of the following:

SB515,23,2 1. Rules defining what constitutes unprofessional conduct for physician assistants for purposes of s. 461.30 (2) (d).

SB515,23,3 2. Rules under s. 461.12 (2).

SB515,23,7 (2) The board shall include in the register the board maintains under s. 440.035 (1m) (d) the names of all persons whose licenses issued under this chapter were suspended or revoked within the past 2 years. The register shall be available for purchase at cost.

SB515,23,11 461.07 License; renewal. (1) (a) Except as provided in par. (b), the board shall grant an initial license to practice as a physician assistant to any applicant who is found qualified by three-fourths of the members of the board and satisfies all of the following requirements, as determined by the board:

SB515,23,14 1. The applicant submits an application on a form provided by the department and pays the initial credential fee determined by the department under s. 440.03 (9) (a).

SB515,23,15 2. The applicant is at least 18 years of age.

SB515,23,16 3. The applicant provides evidence of one of the following:

SB515,23,21 a. That the applicant has successfully completed an educational program for physician assistants or physician associates that is accredited by the Accreditation Review Commission on Education for the Physician Assistant or its successor or, prior to 2001, by the Committee on Allied Health Education and Accreditation or the Commission on Accreditation of Allied Health Education Programs.

SB515,23,25 b. If the applicant does not satisfy subd. 3. a., that the applicant, prior to January 1, 1986, successfully passed the Physician Assistant National Certifying Examination administered by the National Commission on Certification of Physician Assistants.

SB515,24,2 4. The applicant passes the National Commission on Certification of Physician Assistants examination or an equivalent national examination adopted by the board.

SB515,24,4 5. The applicant provides a listing with all employers, practice settings, internships, residencies, fellowships, and other employment for the past 7 years.

SB515,24,6 6. Subject to ss. 111.321, 111.322, and 111.335, the applicant does not have an arrest or conviction record.

SB515,24,13 (b) Paragraph (a) 3. does not apply to an applicant if the applicant provides evidence that he or she is licensed as a physician assistant or physician associate in another state, the District of Columbia, Puerto Rico, the United States Virgin Islands, or any territory or insular possession subject to the jurisdiction of the United States and the board determines that the requirements for obtaining the license in that state or territory are substantially equivalent to the requirements under par. (a).

SB515,24,16 (2) (a) The renewal date for a license issued under this chapter is specified under s. 440.08 (2) (a), and the renewal fees for such licenses are determined by the department under s. 440.03 (9) (a). Renewal of a license is subject to par. (b).

SB515,24,21 (b) An applicant for the renewal of a license under this chapter shall submit with his or her application for renewal proof of having satisfied the continuing education requirements imposed by the board under s. 461.05 (1) (b). This paragraph does not apply to an applicant for renewal of a license that expires on the first renewal date after the date on which the board initially granted the license.

SB515,24,25 (3) Notwithstanding sub. (1), an individual who, on the effective date of this subsection .... [LRB inserts date], was licensed by the medical examining board as a physician assistant under subch. II of ch. 448, 2017 stats., shall be considered to have been licensed under sub. (1) for purposes of this chapter.

SB515,25,4 461.10 Practice and employment. (1) (a) Subject to the limitations and requirements under sub. (2); the physician assistant's experience, education, and training; and any rules promulgated under sub. (5), a physician assistant may do any of the following:

SB515,25,6 1. Examine into the fact, condition, or cause of human health or disease, or treat, operate, prescribe, or advise for the same, by any means or instrumentality.

SB515,25,8 2. Apply principles or techniques of medical sciences in the diagnosis or prevention of any of the conditions described in subd. 1. and in s. 461.01 (2).

SB515,25,9 3. Penetrate, pierce, or sever the tissues of a human being.

SB515,25,11 4. Offer, undertake, attempt, or hold oneself out in any manner as able to do any of the acts described in this paragraph.

SB515,25,15 (b) Subject to any rules promulgated by the board and consistent with his or her experience, education, and training, a physician assistant may order, prescribe, procure, dispense, and administer prescription drugs, medical devices, services, and supplies.

SB515,25,19 (c) A physician assistant may practice in ambulatory care, acute care, long-term care, home care, or other settings as a primary, specialty, or surgical care provider who may serve as a patient's primary care provider or specialty care provider.

SB515,25,22 (2) (a) 1. Except as provided in subd. 3. and sub. (5) (a) or (b), a physician assistant who provides care to patients shall maintain and provide to the board upon request one of the following:

SB515,26,4 a. 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. In this subd. 1. a., “employment” includes an arrangement between the physician assistant and a 3rd party in which the 3rd party receives payment for services provided by the physician assistant.

SB515,26,7 b. A written collaborative agreement with a physician that describes the physician assistant's individual scope of practice and that includes other information as required by the board.

SB515,26,11 c. If the physician assistant's practice is limited to the practice of podiatry, a written collaborative agreement with a podiatrist or physician that describes the physician assistant's individual scope of podiatry practice and that includes other information as required by the board.

SB515,26,13 2. Subdivision 1. does not require the physical presence of a physician or podiatrist at the time and place a physician assistant renders a service.

SB515,26,16 3. Subdivision 1. does not apply with respect to a physician assistant who is employed by the federal government as a civilian or member of the uniformed services while performing duties incident to that employment or service.

SB515,26,18 (b) A physician assistant shall limit his or her practice to the scope of his or her experience, education, and training.

SB515,26,20 (c) No physician assistant may provide medical care, except routine screening and emergency care, in any of the following:

SB515,26,21 1. The practice of dentistry or dental hygiene within the meaning of ch. 447.

SB515,26,22 2. The practice of optometry within the meaning of ch. 449.

SB515,26,23 3. The practice of chiropractic within the meaning of ch. 446.

SB515,26,24 4. The practice of acupuncture within the meaning of ch. 451.

SB515,27,2 (3) (a) It shall be the obligation of a physician assistant to ensure all of the following:

SB515,27,4 1. That the scope of the practice of a physician assistant is identified and is appropriate with respect to his or her experience, education, and training.

SB515,27,6 2. For purposes of sub. (2) (a) 1. b. and c., that the relationship with and access to a collaborating physician or podiatrist by the physician assistant is defined.

SB515,27,8 3. That the requirements and standards of licensure under this chapter are complied with.

SB515,27,13 4. That consultation with and referral to other licensed health care providers with a scope of practice appropriate for a patient's care needs occurs when the patient's care needs exceed the physician assistant's experience, education, or training. A physician assistant shall ensure that he or she has awareness of options for the management of situations that are beyond the physician assistant's expertise.

SB515,27,15 (b) A physician assistant is individually and independently responsible for the quality of the care he or she renders.

SB515,27,20 (4) A physician assistant may delegate a care task or order to another clinically trained health care worker if the physician assistant is competent to perform the delegated task or order and has reasonable evidence that the clinically trained health care worker is minimally competent to perform the task or issue the order under the circumstances.

SB515,27,22 (5) The board shall promulgate any rules necessary to implement this section, including rules to do any of the following:

SB515,27,25 (a) Allow for temporary practice, specifically defined and actively monitored by the board, in the event of an interruption of a collaborative relationship under sub. (2) (a) 1. b. or c.

SB515,28,4 (b) Allow a physician assistant, in the absence of an employment or collaborative relationship under sub. (2) (a) 1., to provide medical care at the scene of an emergency, during a declared state of emergency or other disaster, or when volunteering at sporting events or at camps.

SB515,28,10 (6) The practice permissions provided in this section are permissions granted by the state authorizing the licensed practice of physician assistants. Nothing in this section prohibits an employer, hospital, health plan, or other similar entity employing or with a relationship with a licensed physician assistant from establishing additional requirements for a licensed physician assistant as a condition of employment or relationship.

SB515,28,12 461.11 Civil liability. No physician assistant shall be liable for any civil damages for either of the following:

SB515,28,16 (1) Reporting in good faith to the department of transportation under s. 146.82 (3) a patient's name and other information relevant to a physical or mental condition of the patient that in the physician assistant's judgment impairs the patient's ability to exercise reasonable and ordinary control over a motor vehicle.

SB515,28,20 (2) In good faith, not reporting to the department of transportation under s. 146.82 (3) a patient's name and other information relevant to a physical or mental condition of the patient that in the physician assistant's judgment does not impair the patient's ability to exercise reasonable and ordinary control over a motor vehicle.

SB515,28,24 461.12 Malpractice liability insurance. (1) Except as provided in subs. (2) and (3), no physician assistant may practice as authorized under s. 461.10 unless he or she has in effect malpractice liability insurance coverage evidenced by one of the following:

SB515,29,2 (a) Personal liability coverage in the amounts specified for health care providers under s. 655.23 (4).

SB515,29,4 (b) Coverage under a group liability policy providing individual coverage for the physician assistant in the amounts under s. 655.23 (4).

SB515,29,10 (2) The board may promulgate rules requiring a practicing physician assistant to have in effect malpractice liability insurance coverage in amounts greater than those specified in sub. (1) (a) or (b) or (4). If the board promulgates rules under this subsection, no physician assistant may practice as authorized under s. 461.10 unless he or she has in effect malpractice liability insurance coverage as required under those rules, except as provided in sub. (3).

SB515,29,14 (3) A physician assistant who is a state, county, or municipal employee, or federal employee or contractor covered under the federal tort claims act, as amended, and who is acting within the scope of his or her employment or contractual duties is not required to maintain in effect malpractice insurance coverage.