CSSB 89(L&C): "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 CS FOR SENATE BILL NO. 89(L&C) 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 AS 08.64.107 is repealed and reenacted to read: 14 Sec. 08.64.107.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, except as an assistant to a physician, osteopath, or podiatrist; 08 (2) requirements for a physician assistant to practice a new specialty 09 that are based on the risk and complexity of the specialty; 10 (3) methods of periodic assessment that a collaborating physician may 11 use to evaluate a physician assistant; 12 (4) methods for resolving inconsistencies between hours attested to 13 under (e)(1) and (2) of this section; and 14 (5) methods for confirming the hours attested to by a physician 15 assistant under (e)(1) of this section for circumstances in which the collaborating 16 physician is incapacitated, deceased, or otherwise unavailable to attest to the hours the 17 collaborating physician oversaw under (e)(2) of this section; the regulations must take 18 into consideration the extenuating circumstances causing the collaborating physician 19 to be unavailable to attest to the hours. 20 (b) A physician assistant shall maintain a collaborative agreement while 21 practicing under this section until the board authorizes the physician assistant to 22 practice without a collaborative agreement. The board may authorize a physician 23 assistant to practice in a specialty without a collaborative agreement if 24 (1) the physician assistant has obtained 25 (A) 6,000 hours of postgraduate clinical experience; 26 (B) any hours of postgraduate clinical experience in the 27 specialty required by the board under (d) of this section; and 28 (C) any additional hours of postgraduate clinical experience in 29 the specialty required by the board under (g) of this section; and 30 (2) the board determines that the physician assistant is competent to 31 practice in the specialty without a collaborative agreement under (g) of this section.
01 (c) A physician assistant shall provide a copy of a collaborative agreement 02 required under (b) of this section to the board. The collaborative agreement must 03 (1) be in writing; 04 (2) be maintained with the employer of the physician assistant; 05 (3) describe each specialty in which the physician assistant is obtaining 06 clinical experience under the collaborative agreement; 07 (4) require a collaborating physician who specializes in the same 08 specialties described under (3) of this subsection to oversee the performance, practice, 09 and activities of the physician assistant; if a physician assistant is practicing in a 10 remote area, the collaborating physician may oversee the physician assistant by 11 providing the physician assistant with direct telephonic, electronic, or video access to 12 the collaborating physician or another senior health care provider; and 13 (5) describe the methods of periodic assessment the collaborating 14 physician will use to evaluate the physician assistant's competency, knowledge, and 15 skills. 16 (d) The board may require a physician assistant who seeks authorization to 17 practice in a specialty without a collaborative agreement to obtain up to 4,000 hours of 18 postgraduate clinical experience in each specialty under a collaborative agreement. 19 The physician assistant may obtain the hours of postgraduate clinical experience 20 required under this subsection concurrently with the hours required under (b)(1)(A) of 21 this section. A physician assistant shall notify the board if the physician assistant 22 intends to begin practicing in a new specialty. 23 (e) Upon obtaining the hours of postgraduate clinical experience required 24 under (b)(1)(A), (d), and (g) of this section, 25 (1) the physician assistant shall attest to the board, on a form provided 26 by the board, the number of hours of postgraduate clinical experience obtained by the 27 physician assistant; and 28 (2) the collaborating physician shall attest to the board, on a form 29 provided by the board, the number of hours of postgraduate clinical experience 30 obtained by the physician assistant that the collaborating physician oversaw. 31 (f) The physician assistant and collaborating physician may not retaliate
01 against each other because of an attestation under (e) of this section. 02 (g) The board shall determine whether a physician assistant is competent to 03 practice in a specialty without a collaborative agreement using the information 04 provided to the board under (e) of this section. The board may consider additional 05 information at the request of the physician assistant. If the board determines that the 06 physician assistant is not competent to practice in a specialty without a collaborative 07 agreement, the board may require the physician assistant to obtain up to 500 additional 08 hours of postgraduate clinical experience in the specialty under a collaborative 09 agreement before the board again determines whether the physician assistant is 10 competent to practice in the specialty without a collaborative agreement. 11 * Sec. 3. AS 08.64 is amended by adding a new section to read: 12 Sec. 08.64.206. Qualifications for physician assistant applicants. Each 13 physician assistant applicant shall meet the qualifications prescribed in 14 AS 08.64.200(a)(3) - (5) and shall submit 15 (1) a certificate of graduation obtained from a physician assistant 16 program accredited, at the time of graduation, by 17 (A) the American Medical Association's Committee on Allied 18 Health Education and Accreditation or the Commission on Accreditation of 19 Allied Health Education Programs if the applicant graduated before January 1, 20 2001; or 21 (B) the Accreditation Review Commission on Education for the 22 Physician Assistant if the applicant graduated on or after January 1, 2001; 23 (2) proof of current certification issued by the National Commission on 24 Certification of Physician Assistants; 25 (3) proof of receiving a passing score on the physician assistant 26 national certifying examination offered by the National Commission on Certification 27 of Physician Assistants; and 28 (4) proof of any hours of postgraduate clinical experience obtained by 29 the applicant, including the specialties in which those hours were obtained. 30 * Sec. 4. AS 08.64.230 is amended by adding a new subsection to read: 31 (d) If a physician assistant applicant passes the examination and meets the
01 requirements of AS 08.64.206 and 08.64.255, the board or its executive secretary shall 02 grant a license to the applicant to practice the acts within the practice of medicine, 03 osteopathy, and podiatry, as determined by the board under AS 08.64.107(a). 04 * Sec. 5. AS 08.64.250(a) is amended to read: 05 (a) The board may waive the examination requirement and license by 06 credentials if the physician, osteopath, physician assistant, or podiatry applicant 07 meets the requirements of AS 08.64.200, 08.64.205, 08.64.206, or 08.64.209, submits 08 proof of continued competence as required by regulation, pays the required fee, and 09 has 10 (1) an active license from a board of medical examiners established 11 under the laws of a state or territory of the United States or a province or territory of 12 Canada issued after thorough examination; or 13 (2) passed an examination as specified by the board in regulations. 14 * Sec. 6. AS 08.64.270(a) is amended to read: 15 (a) The board, a member of the board, the executive secretary, or a person 16 designated by the board to issue temporary permits may issue a temporary permit to 17 an [A PHYSICIAN APPLICANT, OSTEOPATH APPLICANT, OR PODIATRY] 18 applicant who meets the requirements of AS 08.64.200, 08.64.205, 08.64.206, 19 08.64.209, or 08.64.225 and pays the required fee. 20 * Sec. 7. AS 08.64.275(a) is amended to read: 21 (a) A member of the board, its executive secretary, or a person designated by 22 the board to issue temporary permits may grant a temporary permit to a physician, 23 [OR] osteopath, or physician assistant for the purpose of 24 (1) substituting for another physician, [OR] osteopath, or physician 25 assistant licensed in this state; 26 (2) being temporarily employed by a physician, [OR] osteopath, or 27 physician assistant licensed in this state while that physician, [OR] osteopath, or 28 physician assistant evaluates the permittee for permanent employment; or 29 (3) being temporarily employed by a hospital or community mental 30 health center while the facility attempts to fill a vacant permanent physician, [OR] 31 osteopath, or physician assistant staff position with a physician, [OR] osteopath, or
01 physician assistant licensed in this state. 02 * Sec. 8. AS 08.64.275 is amended by adding a new subsection to read: 03 (g) A physician assistant applying under (a) of this section shall pay the 04 required fee and shall meet the requirements of AS 08.64.206 and 08.64.279. In 05 addition, the physician assistant shall submit evidence of holding a license to practice 06 in a state or territory of the United States or in a province or territory of Canada. 07 * Sec. 9. AS 08.64.312(c) is amended to read: 08 (c) The board or its designee may exempt a physician, osteopath, [OR] 09 podiatrist, or physician assistant from the requirements of (b) of this section upon an 10 application by the physician, osteopath, [OR] podiatrist, or physician assistant giving 11 evidence satisfactory to the board or its designee that the physician, osteopath, [OR] 12 podiatrist, or physician assistant is unable to comply with the requirements because 13 of extenuating circumstances. However, a person may not be exempted from more 14 than 15 hours of continuing education in a five-year period; a person may not be 15 exempted from the requirement to receive at least two hours of education in pain 16 management and opioid use and addiction unless the person has demonstrated to the 17 satisfaction of the board that the person does not currently hold a valid federal Drug 18 Enforcement Administration registration number. 19 * Sec. 10. AS 08.64.326(a) is amended to read: 20 (a) The board may impose a sanction if the board finds after a hearing that a 21 licensee 22 (1) secured a license through deceit, fraud, or intentional 23 misrepresentation; 24 (2) engaged in deceit, fraud, or intentional misrepresentation while 25 providing professional services or engaging in professional activities; 26 (3) advertised professional services in a false or misleading manner; 27 (4) has been convicted, including conviction based on a guilty plea or 28 plea of nolo contendere, of 29 (A) a class A or unclassified felony or a crime in another 30 jurisdiction with elements similar to a class A or unclassified felony in this 31 jurisdiction;
01 (B) a class B or class C felony or a crime in another jurisdiction 02 with elements similar to a class B or class C felony in this jurisdiction if the 03 felony or other crime is substantially related to the qualifications, functions, or 04 duties of the licensee; or 05 (C) a crime involving the unlawful procurement, sale, 06 prescription, or dispensing of drugs; 07 (5) has procured, sold, prescribed, or dispensed drugs in violation of a 08 law regardless of whether there has been a criminal action or harm to the patient; 09 (6) intentionally or negligently permitted the performance of patient 10 care by persons under the licensee's supervision that does not conform to minimum 11 professional standards even if the patient was not injured; 12 (7) failed to comply with this chapter, a regulation adopted under this 13 chapter, or an order of the board; 14 (8) has demonstrated 15 (A) professional incompetence, gross negligence, or repeated 16 negligent conduct; the board may not base a finding of professional 17 incompetence solely on the basis that a licensee's practice is unconventional or 18 experimental in the absence of demonstrable physical harm to a patient; 19 (B) addiction to, severe dependency on, or habitual overuse of 20 alcohol or other drugs that impairs the licensee's ability to practice safely; 21 (C) unfitness because of physical or mental disability; 22 (9) engaged in unprofessional conduct, in sexual misconduct, or in 23 lewd or immoral conduct in connection with the delivery of professional services to 24 patients; in this paragraph, "sexual misconduct" includes sexual contact, as defined by 25 the board in regulations adopted under this chapter, or attempted sexual contact with a 26 patient outside the scope of generally accepted methods of examination or treatment of 27 the patient, regardless of the patient's consent or lack of consent, during the term of the 28 physician-patient relationship, as defined by the board in regulations adopted under 29 this chapter, unless the patient was the licensee's spouse at the time of the contact or, 30 immediately preceding the physician-patient relationship, was in a dating, courtship, 31 or engagement relationship with the licensee;
01 (10) has violated AS 18.16.010; 02 (11) has violated any code of ethics adopted by regulation by the 03 board; 04 (12) has denied care or treatment to a patient or person seeking 05 assistance from the licensee [PHYSICIAN] if the only reason for the denial is the 06 failure or refusal of the patient to agree to arbitrate as provided in AS 09.55.535(a); 07 (13) has had a license or certificate to practice medicine in another 08 state or territory of the United States, or a province or territory of Canada, denied, 09 suspended, revoked, surrendered while under investigation for an alleged violation, 10 restricted, limited, conditioned, or placed on probation unless the denial, suspension, 11 revocation, or other action was caused by the failure of the licensee to pay fees to that 12 state, territory, or province; or 13 (14) prescribed or dispensed an opioid in excess of the maximum 14 dosage authorized under AS 08.64.363. 15 * Sec. 11. AS 08.64.334 is amended to read: 16 Sec. 08.64.334. Voluntary surrender. The board, at its discretion, may accept 17 the voluntary surrender of a license. A license may not be returned unless the board 18 determines, under regulations adopted by it, that the licensee is competent to resume 19 practice. However, a license may not be returned to the licensee if the voluntary 20 surrender resulted in the dropping or suspension of civil or criminal charges against 21 the physician or physician assistant. 22 * Sec. 12. AS 08.64.336(a) is amended to read: 23 (a) A physician or physician assistant who professionally treats a person 24 licensed to practice medicine or osteopathy in this state for alcoholism or drug 25 addiction, or for mental, emotional, or personality disorders, shall report [IT] to the 26 board if there is probable cause that the person may constitute a danger to the health 27 and welfare of that person's patients or the public if that person continues in practice. 28 The report must state the name and address of the person and the condition found. 29 * Sec. 13. AS 08.64.336(e) is amended to read: 30 (e) A physician, physician assistant, hospital, hospital committee, or private 31 professional organization contracted with under AS 08.64.101(a)(5) to identify,
01 confront, evaluate, and treat individuals licensed under this chapter who abuse 02 addictive substances that in good faith submits a report under this section or 03 participates in an investigation or judicial proceeding related to a report submitted 04 under this section is immune from civil liability for the submission or participation. 05 * Sec. 14. AS 08.64.336(f) is amended to read: 06 (f) A physician, physician assistant, or hospital may not refuse to submit a 07 report under this section or withhold from the board or its investigators evidence 08 related to an investigation under this section on the grounds that the report or evidence 09 (1) concerns a matter that was disclosed in the course of a confidential 10 physician-patient or psychotherapist-patient relationship or during a meeting of a 11 hospital medical staff, governing body, or committee that was exempt from the public 12 meeting requirements of AS 44.62.310; or 13 (2) is required to be kept confidential under AS 18.23.030. 14 * Sec. 15. AS 08.64.360 is amended to read: 15 Sec. 08.64.360. Penalty for practicing without a license or in violation of 16 law. Except for [A PHYSICIAN ASSISTANT OR] a person licensed or authorized 17 under another law of the state who engages in practices for which that person is 18 licensed or authorized under that law, a person practicing medicine or osteopathy in 19 the state without a valid license or permit is guilty of a class A misdemeanor. Each day 20 of illegal practice is a separate offense. 21 * Sec. 16. AS 08.64.370 is amended to read: 22 Sec. 08.64.370. Exceptions to application of chapter. This chapter does not 23 apply to 24 (1) officers in the regular medical service of the armed services of the 25 United States or the United States Public Health Service while in the discharge of their 26 official duties; 27 (2) a physician, [OR] osteopath, or physician assistant licensed in 28 another state who is asked by a physician, [OR] osteopath, or physician assistant 29 licensed in this state to help in the diagnosis or treatment of a case, unless the 30 physician, osteopath, or physician assistant is practicing under AS 08.02.130(b); 31 (3) the practice of the religious tenets of a church;
01 (4) a physician or physician assistant in the regular medical service of 02 the United States Public Health Service or the armed services of the United States 03 volunteering services without pay or other remuneration to a hospital, clinic, medical 04 office, or other medical facility in the state; 05 (5) a person who is certified as a direct-entry midwife by the 06 department under AS 08.65 while engaged in the practice of midwifery whether or not 07 the person accepts compensation for those services; 08 (6) a physician or physician assistant licensed in another state who, 09 under a written agreement with an athletic team located in the state in which the 10 physician or physician assistant is licensed, provides medical services to members of 11 the athletic team while the athletic team is traveling to or from or participating in a 12 sporting event in this state. 13 * Sec. 17. AS 08.64.380(6) is amended to read: 14 (6) "practice of medicine" or "practice of osteopathy" means [:] 15 (A) for a fee, donation, or other consideration, to diagnose, 16 treat, operate on, prescribe for, or administer to [,] any human ailment, 17 blemish, deformity, disease, disfigurement, disorder, injury, or other mental or 18 physical condition; or to attempt to perform or represent that a person is 19 authorized to perform any of the acts set out in this subparagraph; 20 (B) to use or publicly display a title in connection with a 21 person's name in such a manner as to show that the person is willing or 22 qualified to diagnose or treat the sick or injured, including "doctor of 23 medicine," "physician," "M.D.," [OR] "doctor of osteopathic medicine," [OR] 24 "D.O.," "physician assistant," or "P.A." or a specialist designation, 25 including "surgeon," "dermatologist," or a similar title, except that "practice 26 of medicine" or "practice of osteopathy" does not include the use of the 27 title "doctor" by a person holding a doctorate degree who is not a 28 physician or osteopath and who clearly communicates that the person is 29 not a physician or osteopath [IN SUCH A MANNER AS TO SHOW THAT 30 THE PERSON IS WILLING OR QUALIFIED TO DIAGNOSE OR TREAT 31 THE SICK OR INJURED];
01 * Sec. 18. AS 08.64.380(7) is amended to read: 02 (7) "practice of podiatry" means the medical, mechanical, and surgical 03 treatment of ailments of the foot, the muscles and tendons of the leg governing the 04 functions of the foot, and superficial lesions of the hand other than those associated 05 with trauma; the use of preparations, medicines, and drugs as are necessary for the 06 treatment of these ailments; the treatment of the local manifestations of systemic 07 diseases as they appear in the hand and foot, except that 08 (A) a patient shall be concurrently referred to a physician, [OR] 09 osteopath, or physician assistant for the treatment of the systemic disease 10 itself; 11 (B) general anaesthetics may be used only in colleges of 12 podiatry approved by the board and in hospitals approved by the joint 13 commission on the accreditation of hospitals, or the American Osteopathic 14 Association; and 15 (C) the use of X-ray or radium for therapeutic purposes is not 16 permitted. 17 * Sec. 19. AS 11.71.900(20) is amended to read: 18 (20) "practitioner" means 19 (A) a physician, physician assistant, dentist, advanced practice 20 registered nurse, optometrist, veterinarian, scientific investigator, or other 21 person licensed, registered, or otherwise permitted to distribute, dispense, 22 conduct research with respect to, or to administer or use in teaching or 23 chemical analysis a controlled substance in the course of professional practice 24 or research in the state; 25 (B) a pharmacy, hospital, or other institution licensed, 26 registered, or otherwise permitted to distribute, dispense, conduct research with 27 respect to, or to administer a controlled substance in the course of professional 28 practice or research in the state; 29 * Sec. 20. AS 13.52.390(31) is amended to read: 30 (31) "physician assistant" means an individual licensed as a physician 31 assistant under AS 08.64 [AS 08.64.107].
01 * Sec. 21. AS 18.08.089(a) is amended to read: 02 (a) A mobile intensive care paramedic licensed under this chapter, a physician 03 assistant registered or licensed under AS 08.64 [AS 08.64.107], or an emergency 04 medical technician certified under this chapter may make a determination and 05 pronouncement of death of a person under the following circumstances: 06 (1) the mobile intensive care paramedic or emergency medical 07 technician is an active member of an emergency medical service certified under this 08 chapter; 09 (2) neither a physician licensed under AS 08.64 nor a physician 10 exempt from licensure under AS 08.64 is immediately available for consultation by 11 radio or telephone communications; 12 (3) the mobile intensive care paramedic, physician assistant, or 13 emergency medical technician has determined, based on acceptable medical standards, 14 that the person has sustained irreversible cessation of circulatory and respiratory 15 functions. 16 * Sec. 22. AS 21.07.010(b) is amended to read: 17 (b) A contract between a participating health care provider and a health care 18 insurer that offers a health care insurance policy may not contain a provision that 19 (1) has as its predominant purpose the creation of direct financial 20 incentives to the health care provider for withholding covered medical care services 21 that are medically necessary; nothing in this paragraph shall be construed to prohibit a 22 contract between a participating health care provider and a health care insurer from 23 containing incentives for efficient management of the utilization and cost of covered 24 medical care services; 25 (2) requires the provider to contract for all products that are currently 26 offered or that may be offered in the future by the health care insurer; [OR] 27 (3) requires the health care provider to be compensated for medical 28 care services performed at the same rate as the health care provider has contracted 29 with another health care insurer; or 30 (4) imposes a practice, education, or collaboration requirement on 31 physician assistants that is inconsistent with or more restrictive than the
01 requirements imposed under AS 08.64 or a regulation adopted by the State 02 Medical Board. 03 * Sec. 23. AS 23.30.395(3) is amended to read: 04 (3) "attending physician" means one of the following designated by the 05 employee under AS 23.30.095(a) or (b): 06 (A) a licensed medical doctor; 07 (B) a licensed doctor of osteopathy; 08 (C) a licensed dentist or dental surgeon; 09 (D) a licensed physician assistant [ACTING UNDER 10 SUPERVISION OF A LICENSED MEDICAL DOCTOR OR DOCTOR OF 11 OSTEOPATHY]; 12 (E) a licensed advanced practice registered nurse; or 13 (F) a licensed chiropractor; 14 * Sec. 24. AS 33.30.901(10) is amended to read: 15 (10) "health care provider" means 16 (A) a physician assistant licensed to practice in the state [AND 17 WORKING UNDER THE DIRECT SUPERVISION OF A LICENSED 18 PHYSICIAN OR PSYCHIATRIST]; 19 (B) a mental health professional as defined in AS 47.30.915; or 20 (C) an advanced practice registered nurse as defined in 21 AS 08.68.850; 22 * Sec. 25. AS 08.64.170(a)(1) is repealed.