SB 89: "An Act relating to physician assistants; relating to collaborative agreements between physicians and physician assistants; relating to the practice of medicine; relating to health care providers; and relating to provisions regarding physician assistants in contracts between certain health care providers and health care insurers."
00 SENATE BILL NO. 89 01 "An Act relating to physician assistants; relating to collaborative agreements between 02 physicians and physician assistants; relating to the practice of medicine; relating to 03 health care providers; and relating to provisions regarding physician assistants in 04 contracts between certain health care providers and health care insurers." 05 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA: 06 * Section 1. AS 08.64.010 is amended to read: 07 Sec. 08.64.010. Creation and membership of State Medical Board. The 08 governor shall appoint a board of medical examiners, to be known as the State 09 Medical Board, consisting of five physicians licensed in the state and residing in as 10 many separate geographical areas of the state as possible, one physician assistant 11 licensed in the state [UNDER AS 08.64.107], and two persons with no direct 12 financial interest in the health care industry. 13 * Sec. 2. AS 08.64.107 is repealed and reenacted to read: 14 Sec. 08.64.107. Scope of practice of physician assistants; collaborative
01 agreements. (a) The board shall adopt regulations establishing 02 (1) acts within the practice of medicine, osteopathy, and podiatry that 03 physician assistants may perform; the regulations must, at a minimum, allow physician 04 assistants to perform acts that physician assistants are generally educated and trained 05 to perform by accredited physician assistant programs described in AS 08.64.206(1); 06 the regulations may not allow a physician assistant to perform surgery or operate on a 07 human without assistance; 08 (2) requirements for a physician assistant to practice a new specialty; 09 and 10 (3) methods of periodic assessment that a collaborating physician may 11 use to evaluate a physician assistant. 12 (b) Except as provided in (d) of this section, a physician assistant with less 13 than 4,000 hours of postgraduate clinical experience may practice only under a 14 collaborative agreement maintained with the employer of the physician assistant. The 15 collaborative agreement must 16 (1) be in writing; 17 (2) require a collaborating physician to oversee the performance, 18 practice, and activities of the physician assistant; 19 (3) describe the methods of periodic assessment the collaborating 20 physician will use to evaluate the physician assistant's competency, knowledge, and 21 skills; and 22 (4) describe each specialty in which the physician assistant is obtaining 23 clinical experience under the collaborative agreement. 24 (c) If a physician assistant is practicing in a remote area, a collaborating 25 physician may oversee the physician assistant under (b)(2) of this section by providing 26 the physician assistant with direct telephonic, electronic, or video access to the 27 collaborating physician or another senior health care provider. 28 (d) A physician assistant shall notify the board if the physician assistant begins 29 practicing in a new specialty. If the board determines that the new specialty requires 30 the physician assistant to obtain additional hours of postgraduate clinical experience, 31 the physician assistant may practice only under a collaborative agreement maintained
01 with the employer of the physician assistant until the hours of postgraduate clinical 02 experience required under this subsection and (b) of this section are obtained. 03 (e) A physician assistant shall provide a copy of the collaborative agreement 04 to the board. Upon obtaining the hours of postgraduate clinical experience required 05 under (b) and (d) of this section, the physician assistant shall notify the board and 06 attest to the number of hours of postgraduate clinical experience obtained by the 07 physician assistant on a form provided by the board. 08 (f) The board may not require a physician assistant to obtain hours of 09 postgraduate clinical experience in excess of the 4,000 hours required under (b) of this 10 section and the additional hours required when practicing a new specialty under (d) of 11 this section. 12 * Sec. 3. AS 08.64 is amended by adding a new section to read: 13 Sec. 08.64.206. Qualifications for physician assistant applicants. Each 14 physician assistant applicant shall meet the qualifications prescribed in 15 AS 08.64.200(a)(3) - (5) and shall submit 16 (1) a certificate of graduation obtained from a physician assistant 17 program accredited, at the time of graduation, by 18 (A) the American Medical Association's Committee on Allied 19 Health Education and Accreditation or the Commission on Accreditation of 20 Allied Health Education Programs if the applicant graduated before January 1, 21 2001; or 22 (B) the Accreditation Review Commission on Education for the 23 Physician Assistant if the applicant graduated on or after January 1, 2001; 24 (2) proof of current certification issued by the National Commission on 25 Certification of Physician Assistants; 26 (3) proof of receiving a passing score on the physician assistant 27 national certifying examination offered by the National Commission on Certification 28 of Physician Assistants; 29 (4) proof of any hours of postgraduate clinical experience obtained by 30 the applicant, including the specialties in which those hours were obtained. 31 * Sec. 4. AS 08.64.230 is amended by adding a new subsection to read:
01 (d) If a physician assistant applicant passes the examination and meets the 02 requirements of AS 08.64.206 and 08.64.255, the board or its executive secretary shall 03 grant a license to the applicant to practice the acts within the practice of medicine, 04 osteopathy, and podiatry, as determined by the board under AS 08.64.107(a). 05 * Sec. 5. AS 08.64.250(a) is amended to read: 06 (a) The board may waive the examination requirement and license by 07 credentials if the physician, osteopath, physician assistant, or podiatry applicant 08 meets the requirements of AS 08.64.200, 08.64.205, 08.64.206, or 08.64.209, submits 09 proof of continued competence as required by regulation, pays the required fee, and 10 has 11 (1) an active license from a board of medical examiners established 12 under the laws of a state or territory of the United States or a province or territory of 13 Canada issued after thorough examination; or 14 (2) passed an examination as specified by the board in regulations. 15 * Sec. 6. AS 08.64.270(a) is amended to read: 16 (a) The board, a member of the board, the executive secretary, or a person 17 designated by the board to issue temporary permits may issue a temporary permit to 18 an [A PHYSICIAN APPLICANT, OSTEOPATH APPLICANT, OR PODIATRY] 19 applicant who meets the requirements of AS 08.64.200, 08.64.205, 08.64.206, 20 08.64.209, or 08.64.225 and pays the required fee. 21 * Sec. 7. AS 08.64.275(a) is amended to read: 22 (a) A member of the board, its executive secretary, or a person designated by 23 the board to issue temporary permits may grant a temporary permit to a physician, 24 [OR] osteopath, or physician assistant for the purpose of 25 (1) substituting for another physician, [OR] osteopath, or physician 26 assistant licensed in this state; 27 (2) being temporarily employed by a physician, [OR] osteopath, or 28 physician assistant licensed in this state while that physician, [OR] osteopath, or 29 physician assistant evaluates the permittee for permanent employment; or 30 (3) being temporarily employed by a hospital or community mental 31 health center while the facility attempts to fill a vacant permanent physician, [OR]
01 osteopath, or physician assistant staff position with a physician, [OR] osteopath, or 02 physician assistant licensed in this state. 03 * Sec. 8. AS 08.64.275 is amended by adding a new subsection to read: 04 (g) A physician assistant applying under (a) of this section shall pay the 05 required fee and shall meet the requirements of AS 08.64.206 and 08.64.279. In 06 addition, the physician assistant shall submit evidence of holding a license to practice 07 in a state or territory of the United States or in a province or territory of Canada. 08 * Sec. 9. AS 08.64.312(c) is amended to read: 09 (c) The board or its designee may exempt a physician, osteopath, [OR] 10 podiatrist, or physician assistant from the requirements of (b) of this section upon an 11 application by the physician, osteopath, [OR] podiatrist, or physician assistant giving 12 evidence satisfactory to the board or its designee that the physician, osteopath, [OR] 13 podiatrist, or physician assistant is unable to comply with the requirements because 14 of extenuating circumstances. However, a person may not be exempted from more 15 than 15 hours of continuing education in a five-year period; a person may not be 16 exempted from the requirement to receive at least two hours of education in pain 17 management and opioid use and addiction unless the person has demonstrated to the 18 satisfaction of the board that the person does not currently hold a valid federal Drug 19 Enforcement Administration registration number. 20 * Sec. 10. AS 08.64.326(a) is amended to read: 21 (a) The board may impose a sanction if the board finds after a hearing that a 22 licensee 23 (1) secured a license through deceit, fraud, or intentional 24 misrepresentation; 25 (2) engaged in deceit, fraud, or intentional misrepresentation while 26 providing professional services or engaging in professional activities; 27 (3) advertised professional services in a false or misleading manner; 28 (4) has been convicted, including conviction based on a guilty plea or 29 plea of nolo contendere, of 30 (A) a class A or unclassified felony or a crime in another 31 jurisdiction with elements similar to a class A or unclassified felony in this
01 jurisdiction; 02 (B) a class B or class C felony or a crime in another jurisdiction 03 with elements similar to a class B or class C felony in this jurisdiction if the 04 felony or other crime is substantially related to the qualifications, functions, or 05 duties of the licensee; or 06 (C) a crime involving the unlawful procurement, sale, 07 prescription, or dispensing of drugs; 08 (5) has procured, sold, prescribed, or dispensed drugs in violation of a 09 law regardless of whether there has been a criminal action or harm to the patient; 10 (6) intentionally or negligently permitted the performance of patient 11 care by persons under the licensee's supervision that does not conform to minimum 12 professional standards even if the patient was not injured; 13 (7) failed to comply with this chapter, a regulation adopted under this 14 chapter, or an order of the board; 15 (8) has demonstrated 16 (A) professional incompetence, gross negligence, or repeated 17 negligent conduct; the board may not base a finding of professional 18 incompetence solely on the basis that a licensee's practice is unconventional or 19 experimental in the absence of demonstrable physical harm to a patient; 20 (B) addiction to, severe dependency on, or habitual overuse of 21 alcohol or other drugs that impairs the licensee's ability to practice safely; 22 (C) unfitness because of physical or mental disability; 23 (9) engaged in unprofessional conduct, in sexual misconduct, or in 24 lewd or immoral conduct in connection with the delivery of professional services to 25 patients; in this paragraph, "sexual misconduct" includes sexual contact, as defined by 26 the board in regulations adopted under this chapter, or attempted sexual contact with a 27 patient outside the scope of generally accepted methods of examination or treatment of 28 the patient, regardless of the patient's consent or lack of consent, during the term of the 29 physician-patient relationship, as defined by the board in regulations adopted under 30 this chapter, unless the patient was the licensee's spouse at the time of the contact or, 31 immediately preceding the physician-patient relationship, was in a dating, courtship,
01 or engagement relationship with the licensee; 02 (10) has violated AS 18.16.010; 03 (11) has violated any code of ethics adopted by regulation by the 04 board; 05 (12) has denied care or treatment to a patient or person seeking 06 assistance from the licensee [PHYSICIAN] if the only reason for the denial is the 07 failure or refusal of the patient to agree to arbitrate as provided in AS 09.55.535(a); 08 (13) has had a license or certificate to practice medicine in another 09 state or territory of the United States, or a province or territory of Canada, denied, 10 suspended, revoked, surrendered while under investigation for an alleged violation, 11 restricted, limited, conditioned, or placed on probation unless the denial, suspension, 12 revocation, or other action was caused by the failure of the licensee to pay fees to that 13 state, territory, or province; or 14 (14) prescribed or dispensed an opioid in excess of the maximum 15 dosage authorized under AS 08.64.363. 16 * Sec. 11. AS 08.64.334 is amended to read: 17 Sec. 08.64.334. Voluntary surrender. The board, at its discretion, may accept 18 the voluntary surrender of a license. A license may not be returned unless the board 19 determines, under regulations adopted by it, that the licensee is competent to resume 20 practice. However, a license may not be returned to the licensee if the voluntary 21 surrender resulted in the dropping or suspension of civil or criminal charges against 22 the physician or physician assistant. 23 * Sec. 12. AS 08.64.336(a) is amended to read: 24 (a) A physician or physician assistant who professionally treats a person 25 licensed to practice medicine or osteopathy in this state for alcoholism or drug 26 addiction, or for mental, emotional, or personality disorders, shall report [IT] to the 27 board if there is probable cause that the person may constitute a danger to the health 28 and welfare of that person's patients or the public if that person continues in practice. 29 The report must state the name and address of the person and the condition found. 30 * Sec. 13. AS 08.64.336(e) is amended to read: 31 (e) A physician, physician assistant, hospital, hospital committee, or private
01 professional organization contracted with under AS 08.64.101(a)(5) to identify, 02 confront, evaluate, and treat individuals licensed under this chapter who abuse 03 addictive substances that in good faith submits a report under this section or 04 participates in an investigation or judicial proceeding related to a report submitted 05 under this section is immune from civil liability for the submission or participation. 06 * Sec. 14. AS 08.64.336(f) is amended to read: 07 (f) A physician, physician assistant, or hospital may not refuse to submit a 08 report under this section or withhold from the board or its investigators evidence 09 related to an investigation under this section on the grounds that the report or evidence 10 (1) concerns a matter that was disclosed in the course of a confidential 11 physician-patient or psychotherapist-patient relationship or during a meeting of a 12 hospital medical staff, governing body, or committee that was exempt from the public 13 meeting requirements of AS 44.62.310; or 14 (2) is required to be kept confidential under AS 18.23.030. 15 * Sec. 15. AS 08.64.360 is amended to read: 16 Sec. 08.64.360. Penalty for practicing without a license or in violation of 17 law. Except for [A PHYSICIAN ASSISTANT OR] a person licensed or authorized 18 under another law of the state who engages in practices for which that person is 19 licensed or authorized under that law, a person practicing medicine or osteopathy in 20 the state without a valid license or permit is guilty of a class A misdemeanor. Each day 21 of illegal practice is a separate offense. 22 * Sec. 16. AS 08.64.370 is amended to read: 23 Sec. 08.64.370. Exceptions to application of chapter. This chapter does not 24 apply to 25 (1) officers in the regular medical service of the armed services of the 26 United States or the United States Public Health Service while in the discharge of their 27 official duties; 28 (2) a physician, [OR] osteopath, or physician assistant licensed in 29 another state who is asked by a physician, [OR] osteopath, or physician assistant 30 licensed in this state to help in the diagnosis or treatment of a case, unless the 31 physician, osteopath, or physician assistant is practicing under AS 08.02.130(b);
01 (3) the practice of the religious tenets of a church; 02 (4) a physician or physician assistant in the regular medical service of 03 the United States Public Health Service or the armed services of the United States 04 volunteering services without pay or other remuneration to a hospital, clinic, medical 05 office, or other medical facility in the state; 06 (5) a person who is certified as a direct-entry midwife by the 07 department under AS 08.65 while engaged in the practice of midwifery whether or not 08 the person accepts compensation for those services; 09 (6) a physician or physician assistant licensed in another state who, 10 under a written agreement with an athletic team located in the state in which the 11 physician or physician assistant is licensed, provides medical services to members of 12 the athletic team while the athletic team is traveling to or from or participating in a 13 sporting event in this state. 14 * Sec. 17. AS 08.64.380(6) is amended to read: 15 (6) "practice of medicine" or "practice of osteopathy" means [:] 16 (A) for a fee, donation, or other consideration, to diagnose, 17 treat, operate on, prescribe for, or administer to [,] any human ailment, 18 blemish, deformity, disease, disfigurement, disorder, injury, or other mental or 19 physical condition; or to attempt to perform or represent that a person is 20 authorized to perform any of the acts set out in this subparagraph; 21 (B) to use or publicly display a title in connection with a 22 person's name, including "doctor of medicine," "physician," "M.D.," [OR] 23 "doctor of osteopathic medicine," [OR] "D.O.," "physician assistant," or 24 "P.A." or a specialist designation including "surgeon," "dermatologist," or a 25 similar title in such a manner as to show that the person is willing or qualified 26 to diagnose or treat the sick or injured; 27 * Sec. 18. AS 08.64.380(7) is amended to read: 28 (7) "practice of podiatry" means the medical, mechanical, and surgical 29 treatment of ailments of the foot, the muscles and tendons of the leg governing the 30 functions of the foot, and superficial lesions of the hand other than those associated 31 with trauma; the use of preparations, medicines, and drugs as are necessary for the
01 treatment of these ailments; the treatment of the local manifestations of systemic 02 diseases as they appear in the hand and foot, except that 03 (A) a patient shall be concurrently referred to a physician, [OR] 04 osteopath, or physician assistant for the treatment of the systemic disease 05 itself; 06 (B) general anaesthetics may be used only in colleges of 07 podiatry approved by the board and in hospitals approved by the joint 08 commission on the accreditation of hospitals, or the American Osteopathic 09 Association; and 10 (C) the use of X-ray or radium for therapeutic purposes is not 11 permitted. 12 * Sec. 19. AS 11.71.900(20) is amended to read: 13 (20) "practitioner" means 14 (A) a physician, physician assistant, dentist, advanced practice 15 registered nurse, optometrist, veterinarian, scientific investigator, or other 16 person licensed, registered, or otherwise permitted to distribute, dispense, 17 conduct research with respect to, or to administer or use in teaching or 18 chemical analysis a controlled substance in the course of professional practice 19 or research in the state; 20 (B) a pharmacy, hospital, or other institution licensed, 21 registered, or otherwise permitted to distribute, dispense, conduct research with 22 respect to, or to administer a controlled substance in the course of professional 23 practice or research in the state; 24 * Sec. 20. AS 13.52.390(31) is amended to read: 25 (31) "physician assistant" means an individual licensed as a physician 26 assistant under AS 08.64 [AS 08.64.107]. 27 * Sec. 21. AS 18.08.089(a) is amended to read: 28 (a) A mobile intensive care paramedic licensed under this chapter, a physician 29 assistant registered or licensed under AS 08.64 [AS 08.64.107], or an emergency 30 medical technician certified under this chapter may make a determination and 31 pronouncement of death of a person under the following circumstances:
01 (1) the mobile intensive care paramedic or emergency medical 02 technician is an active member of an emergency medical service certified under this 03 chapter; 04 (2) neither a physician licensed under AS 08.64 nor a physician 05 exempt from licensure under AS 08.64 is immediately available for consultation by 06 radio or telephone communications; 07 (3) the mobile intensive care paramedic, physician assistant, or 08 emergency medical technician has determined, based on acceptable medical standards, 09 that the person has sustained irreversible cessation of circulatory and respiratory 10 functions. 11 * Sec. 22. AS 21.07.010(b) is amended to read: 12 (b) A contract between a participating health care provider and a health care 13 insurer that offers a health care insurance policy may not contain a provision that 14 (1) has as its predominant purpose the creation of direct financial 15 incentives to the health care provider for withholding covered medical care services 16 that are medically necessary; nothing in this paragraph shall be construed to prohibit a 17 contract between a participating health care provider and a health care insurer from 18 containing incentives for efficient management of the utilization and cost of covered 19 medical care services; 20 (2) requires the provider to contract for all products that are currently 21 offered or that may be offered in the future by the health care insurer; [OR] 22 (3) requires the health care provider to be compensated for medical 23 care services performed at the same rate as the health care provider has contracted 24 with another health care insurer; or 25 (4) imposes a practice, education, or collaboration requirement on 26 physician assistants that is inconsistent with or more restrictive than the 27 requirements imposed under AS 08.64 or a regulation adopted by the State 28 Medical Board. 29 * Sec. 23. AS 23.30.395(3) is amended to read: 30 (3) "attending physician" means one of the following designated by the 31 employee under AS 23.30.095(a) or (b):
01 (A) a licensed medical doctor; 02 (B) a licensed doctor of osteopathy; 03 (C) a licensed dentist or dental surgeon; 04 (D) a licensed physician assistant [ACTING UNDER 05 SUPERVISION OF A LICENSED MEDICAL DOCTOR OR DOCTOR OF 06 OSTEOPATHY]; 07 (E) a licensed advanced practice registered nurse; or 08 (F) a licensed chiropractor; 09 * Sec. 24. AS 33.30.901(10) is amended to read: 10 (10) "health care provider" means 11 (A) a physician assistant licensed to practice in the state [AND 12 WORKING UNDER THE DIRECT SUPERVISION OF A LICENSED 13 PHYSICIAN OR PSYCHIATRIST]; 14 (B) a mental health professional as defined in AS 47.30.915; or 15 (C) an advanced practice registered nurse as defined in 16 AS 08.68.850; 17 * Sec. 25. AS 08.64.170(a)(1) is repealed.