HCS CSSB 115(L&C): "An Act relating to physician assistants; relating to physicians; and relating to health care insurance policies."
00 HOUSE CS FOR CS FOR SENATE BILL NO. 115(L&C) 01 "An Act relating to physician assistants; relating to physicians; and relating to health 02 care insurance policies." 03 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA: 04 * Section 1. AS 08.64.107 is amended to read: 05 Sec. 08.64.107. Licensure and scope of practice [REGULATION] of 06 physician assistants. The board shall adopt regulations regarding the licensure of 07 physician assistants and the medical services that they may perform, including the 08 (1) educational and other qualifications, including education in pain 09 management and opioid use and addiction; 10 (2) application and licensing procedures; 11 (3) scope of activities authorized in this section; [AND] 12 (4) responsibilities of a [THE] supervising or training physician; and 13 (5) hours of practice experience, if any, that a physician assistant 14 must complete under a collaborative agreement to practice in a practice area that
01 is substantively different than the physician assistant's previous practice areas; 02 the board may not require that a physician assistant complete more than 4,000 03 hours under this paragraph, in addition to the hours required under (c) and (f) of 04 this section, to practice in a new practice area without a collaborative agreement. 05 * Sec. 2. AS 08.64.107 is amended by adding new subsections to read: 06 (b) A physician assistant may 07 (1) perform a comprehensive health history and physical examination 08 of a patient; 09 (2) evaluate, diagnose, manage, and treat disease and injury; 10 (3) order, perform, and interpret diagnostic studies and therapeutic 11 procedures in compliance with regulations adopted under AS 08.64.106; 12 (4) educate patients on health promotion and disease prevention; 13 (5) provide consultation upon request; 14 (6) write medical orders; 15 (7) supervise and delegate therapeutic and diagnostic measures to 16 licensed or unlicensed personnel, in compliance with regulations adopted under 17 AS 08.64.106; 18 (8) request, receive, and sign for professional samples and distribute 19 professional samples to patients; 20 (9) authenticate by signature, certification, stamp, verification, 21 affidavit, or endorsement a document that a physician would be authorized to 22 authenticate by signature, certification, stamp, verification, affidavit, or endorsement; 23 (10) prescribe, dispense, order, administer, and procure drugs and 24 medical devices; 25 (11) prescribe, dispense, order, and administer a schedule II, III, IV, or 26 V controlled substance under federal law if the physician assistant has a valid federal 27 Drug Enforcement Administration registration number; and 28 (12) plan and initiate a therapeutic regimen that includes ordering and 29 prescribing non-pharmacological interventions, including durable medical equipment, 30 nutrition, blood, blood products, home health care, hospice, physical or occupational 31 therapy, and other diagnostic support services.
01 (c) Unless additional hours are required under (a)(5) or (f) of this section, a 02 physician assistant with less than 6,000 hours of practice experience may practice only 03 under a collaborative agreement in a hospital, clinic, or other clinical setting in which 04 the physician assistant works with a collaborating physician to provide patient care. 05 The collaborating physician shall oversee the performance, practice, and activities of 06 the physician assistant, and the physician assistant must be able to communicate 07 during work hours, in person or by telephone or another telecommunications device, 08 with the collaborating physician. The collaborative agreement must 09 (1) be in writing; 10 (2) be between a physician assistant and a collaborating physician who 11 practices in each of the practice areas of the physician assistant; 12 (3) describe the practice areas of the physician assistant and the 13 collaborating physician; 14 (4) describe how collaboration will occur in accordance with this 15 chapter; 16 (5) describe the methods to be used for evaluating the physician 17 assistant's competency, knowledge, and skills; 18 (6) establish that the physician assistant and collaborating physician 19 have knowledge of the physician assistant's qualifications and limitations in caring for 20 patients; 21 (7) require the physician assistant to consult with the collaborating 22 physician while remaining responsible for care provided by the physician assistant; 23 and 24 (8) require the collaborating physician to give direction and guidance 25 to the physician assistant. 26 (d) The physician assistant or collaborating physician shall provide a copy of 27 the collaborative agreement, along with documentation of compliance, to the board 28 upon request of the board. 29 (e) A physician assistant and collaborating physician shall maintain a record 30 on a form provided by the department of the number of hours of practice experience 31 obtained by the physician assistant. The form must include the
01 (1) area of practice specialty of the collaborating physician; and 02 (2) hours completed by practice type. 03 (f) Upon the physician assistant's completion of 4,000 hours of practice 04 experience, additional hours required under (a)(5) of this section, or additional hours 05 required under this subsection, the collaborating physician shall attest on a form 06 provided by the department that the physician assistant is competent to practice 07 without supervision. If the collaborating physician determines that the physician 08 assistant is not competent to practice without supervision, the board shall require that 09 the physician assistant practice under a collaborative agreement for additional hours, 10 as determined by the board. 11 (g) A physician assistant is entitled to a hearing conducted by the board to 12 appeal a determination by a collaborating physician that the physician assistant is not 13 competent to practice without supervision. The physician assistant may appeal an 14 adverse decision of the board to a court of competent jurisdiction. The board or court 15 may reverse the collaborating physician's determination that the physician assistant is 16 not competent to practice without supervision if the board or court finds that the 17 collaborating physician's determination was arbitrary and capricious or without just 18 cause. 19 (h) The board shall randomly audit three percent of the physician assistants 20 licensed under this section to assess each physician assistant's compliance with the 21 requirements of this chapter. 22 (i) Before a physician assistant may provide services under this section, the 23 physician assistant must inform the patient that the services will be performed by a 24 physician assistant. 25 (j) In this section, "collaborative agreement" means a plan that is mutually 26 agreed on by a physician assistant and a collaborating physician that designates the 27 scope of services the physician assistant may provide to patients. 28 * Sec. 3. AS 08.64.170(a) is amended to read: 29 (a) A person may not practice medicine, podiatry, or osteopathy in the state 30 unless the person is licensed under this chapter, except that 31 (1) a physician assistant may examine, diagnose, or treat persons as
01 authorized in AS 08.64.107 [UNDER THE SUPERVISION, CONTROL, AND 02 RESPONSIBILITY OF EITHER A PHYSICIAN LICENSED UNDER THIS 03 CHAPTER OR A PHYSICIAN EXEMPTED FROM LICENSING UNDER 04 AS 08.64.370]; 05 (2) a person who is licensed or authorized under another law of the 06 state may engage in a practice that is authorized under that law; and 07 (3) a person may perform routine medical duties delegated under 08 AS 08.64.106. 09 * Sec. 4. AS 11.71.900(20) is amended to read: 10 (20) "practitioner" means 11 (A) a physician, physician assistant, dentist, advanced practice 12 registered nurse, optometrist, veterinarian, scientific investigator, or other 13 person licensed, registered, or otherwise permitted to distribute, dispense, 14 conduct research with respect to, or to administer or use in teaching or 15 chemical analysis a controlled substance in the course of professional practice 16 or research in the state; 17 (B) a pharmacy, hospital, or other institution licensed, 18 registered, or otherwise permitted to distribute, dispense, conduct research with 19 respect to, or to administer a controlled substance in the course of professional 20 practice or research in the state; 21 * Sec. 5. AS 21.07.010(b) is amended to read: 22 (b) A contract between a participating health care provider and a health care 23 insurer that offers a health care insurance policy may not contain a provision that 24 (1) has as its predominant purpose the creation of direct financial 25 incentives to the health care provider for withholding covered medical care services 26 that are medically necessary; nothing in this paragraph shall be construed to prohibit a 27 contract between a participating health care provider and a health care insurer from 28 containing incentives for efficient management of the utilization and cost of covered 29 medical care services; 30 (2) requires the provider to contract for all products that are currently 31 offered or that may be offered in the future by the health care insurer; [OR]
01 (3) requires the health care provider to be compensated for medical 02 care services performed at the same rate as the health care provider has contracted 03 with another health care insurer; or 04 (4) imposes a practice, education, or collaboration requirement on 05 physician assistants that is inconsistent with or more restrictive than the 06 requirements imposed under AS 08.64.107 or a regulation adopted by the State 07 Medical Board. 08 * Sec. 6. AS 23.30.395(3) is amended to read: 09 (3) "attending physician" means one of the following designated by the 10 employee under AS 23.30.095(a) or (b): 11 (A) a licensed medical doctor; 12 (B) a licensed doctor of osteopathy; 13 (C) a licensed dentist or dental surgeon; 14 (D) a licensed physician assistant [ACTING UNDER 15 SUPERVISION OF A LICENSED MEDICAL DOCTOR OR DOCTOR OF 16 OSTEOPATHY]; 17 (E) a licensed advanced practice registered nurse; or 18 (F) a licensed chiropractor; 19 * Sec. 7. AS 33.30.901(10) is amended to read: 20 (10) "health care provider" means 21 (A) a physician assistant licensed to practice in the state [AND 22 WORKING UNDER THE DIRECT SUPERVISION OF A LICENSED 23 PHYSICIAN OR PSYCHIATRIST]; 24 (B) a mental health professional as defined in AS 47.30.915; or 25 (C) an advanced practice registered nurse as defined in 26 AS 08.68.850;