Bill Text: CA SB697 | 2019-2020 | Regular Session | Introduced

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Physician assistants: practice agreement: supervision.

Spectrum: Partisan Bill (Democrat 2-0)

Status: (Passed) 2019-10-09 - Chaptered by Secretary of State. Chapter 707, Statutes of 2019. [SB697 Detail]

Download: California-2019-SB697-Introduced.html

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CALIFORNIA LEGISLATURE— 2019–2020 REGULAR SESSION

Senate Bill

No. 697

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Introduced by Senator Caballero
(Coauthor: Assembly Member Friedman)

February 22, 2019

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An act to amend Sections 3500, 3501, 3502, 3502.1, 3502.3, 3502.5, 3504, 3509, 3517, 3518, 3519, 3519.5, 3524, 3527, 3528, 3530, and 3535 of, and to repeal Sections 3516, 3516.5, 3521, and 3522 of, the Business and Professions Code, relating to healing arts.

LEGISLATIVE COUNSEL'S DIGEST

SB 697, as introduced, Caballero. Physician assistants: scope of practice.

The Physician Assistant Practice Act provides for licensure and regulation of physician assistants by the Physician Assistant Board, which is within the jurisdiction of the Medical Board of California. That act requires the board to issue licenses under the name of the Medical Board of California.

This bill would rename the board the Physician Assistant Board of California and instead provide that the board is within the Department of Consumer Affairs. The bill would require the board to issues licenses under its name.

The act authorizes a physician assistant to perform medical services as set forth by regulations and the act and when those services are rendered under the supervision of a licensed physician and surgeon. The act requires the physician assistant and the supervising physician and surgeon to establish written guidelines and protocols for adequate supervision and a delegation of services agreement.

This bill would instead authorize a physician assistant to perform various medical services, including evaluating, diagnosing, managing, and providing medical treatment, pursuant to a practice agreement or in certain organized health care practice settings if the medical services are provided in collaboration with a physician and surgeon or other qualified health care provider in a manner consistent with the education, training, experience, and competencies of the physician assistant and the standard of care, as specified. The bill would authorize a physician assistant to bill and receive direct payment for medical services they provide.

The act authorizes a physician assistant, under the supervision of a physician and surgeon, to administer or provide medication to a patient, or transmit orally, or in writing on a patient’s record or in a drug order, an order to a person who may lawfully furnish the medication or medical device.

This bill would instead authorize a physician assistant to, unless otherwise prohibited, prescribe, dispense, order, administer, and procure drugs and medical devices to a patient or a person who may lawfully furnish the medication or medical device, as specified. The bill would authorize a physician assistant to initiate a therapeutic regimen that includes ordering and prescribing nonpharmacological interventions, including, but not limited to, durable medical equipment, nutrition, blood and blood products, and diagnostic support services, including, but not limited to, home health care, hospice, and physical and occupational therapy.

The act defines various terms for its purposes.

This bill would revise and change the definitions as applicable to carry out the bill’s provisions. The bill would provide that any reference to “protocols” or “delegation of services agreement” in any other law referencing the act means “practice agreement,” as defined by the act, and that any reference to “supervision” in any other law referencing the act means “collaboration,” as defined by the act. The bill would also make various conforming changes.

The act makes a violation of specified provisions punishable as a misdemeanor.

By revising and recasting the provisions of the act, the bill would change the definition of that crime and would, therefore, result in a state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

Digest Key

Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: YES  

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Bill Text

The people of the State of California do enact as follows:

SECTION 1.

 Section 3500 of the Business and Professions Code is amended to read:

3500.

 In its concern with the growing shortage and geographic maldistribution of health care services in California, the Legislature intends to establish in this chapter a framework for development of a new category of health manpower—the physician assistant.

The purpose of this chapter is to encourage the more effective utilization of the skills of physicians, and physicians and podiatrists practicing in the same medical group practice, by enabling them to delegate health care tasks to qualified physician assistants where this delegation is consistent with the patient’s health and welfare and with the laws and regulations relating to physician assistants. physician assistants, working in health care delivery teams, to optimize safety and access to high quality care.

This chapter is established to encourage the utilization of optimal collaboration between physician assistants by physicians, and by physicians and podiatrists assistants, physicians and surgeons, podiatrists, and other qualified health care providers practicing in the same medical group, health care delivery group, and to provide that existing legal constraints should not be an unnecessary hindrance to the more effective optimal provision of health care services. It is also the purpose of this chapter to allow for innovative development of programs for the education, training, and utilization of physician assistants.

SEC. 2.

 Section 3501 of the Business and Professions Code is amended to read:

3501.

 (a)As used in this chapter:

(1)

(a) “Board” means the Physician Assistant Board. Board of California. Any reference in any provision of law to the Physician Assistant Board shall be deemed to refer to the Physician Assistant Board of California.

(2)

(b) “Approved program” means a program for the education of physician assistants that has been formally approved by the board.

(3)

(c) “Trainee” means a person who is currently enrolled in an approved program.

(4)

(d) “Physician assistant” or “PA ” means a person who meets the requirements of this chapter and is licensed by the board.

(5)“Supervising physician” or “supervising physician and surgeon” means a physician and surgeon licensed by the Medical Board of California or by the Osteopathic Medical Board of California who supervises one or more physician assistants, who possesses a current valid license to practice medicine, and who is not currently on disciplinary probation for improper use of a physician assistant.

(6)“Supervision” means that a licensed physician and surgeon oversees the activities of, and accepts responsibility for, the medical services rendered by a physician assistant.

(e) (1) “Collaboration” means a process in which a physician assistant and one or more physicians and surgeons or other qualified health care providers jointly contribute to the health care and medical treatment of a patient, with each collaborator performing actions that the collaborator is licensed or otherwise authorized to perform.

(2)  Any reference to “supervision” in any other statute or regulation that references this chapter shall mean “collaboration” as defined in paragraph (1).

(f) “Organized health care practice setting” means an entity that is legally organized for the purposes of delivering health care and charged with the responsibility of overseeing its own performance by accessing the performance and treatment provided by its medical professionals through various methods, including, but not limited to, the use of quality and performance goals, utilization review, medical chart review, proctoring, patient outcomes, and the credentialing and privileging systems of the organization.

(7)

(g) “Regulations” means the rules and regulations as set forth in Chapter 13.8 (commencing with Section 1399.500) of Title 16 of the California Code of Regulations.

(8)

(h) “Routine visual screening” means uninvasive nonpharmacological simple testing for visual acuity, visual field defects, color blindness, and depth perception.

(9)

(i) “Program manager” means the staff manager of the diversion program, as designated by the executive officer of the board. The program manager shall have background experience in dealing with substance abuse issues.

(10)“Delegation of services

(j) “Practice agreement” means the writing that delegates to a physician assistant from a supervising physician the medical services the physician assistant is authorized to perform consistent with subdivision (a) of Section 1399.540 of Title 16 of the California Code of Regulations. outlines the collaborative practice relationship between physician assistants and physicians and surgeons or other qualified healthcare providers when a PA is not practicing in any setting, except an organized health care practice setting described in subdivision (e) of Section 3502.

(11)

(k) “Other specified medical services” means tests or examinations performed or ordered by a physician assistant PA practicing in compliance with this chapter or regulations of the Medical Board of California Physician Assistant Board of California promulgated under this chapter.

(12)“Medical records review meeting” means a meeting between the supervising physician and surgeon and the physician assistant during which medical records are reviewed to ensure adequate supervision of the physician assistant functioning under protocols. Medical records review meetings may occur in person or by electronic communication.

(b)A physician assistant acts as an agent of the supervising physician when performing any activity authorized by this chapter or regulations adopted under this chapter.

SEC. 3.

 Section 3502 of the Business and Professions Code is amended to read:

3502.

 (a) (1) Notwithstanding any other law, a physician assistant PA may perform those medical services as set forth by the regulations adopted under this chapter when the services are rendered under the supervision of a licensed physician and surgeon who is not subject to a disciplinary condition imposed by the Medical Board of California prohibiting that supervision or prohibiting the employment of a physician assistant. The medical record, for each episode of care for a patient, shall identify the physician and surgeon who is responsible for the supervision of the physician assistant. pursuant to a practice agreement or in an organized health care practice setting described in subdivision (e).

(b)(1)Notwithstanding any other law, a physician assistant performing medical services under the supervision of a physician and surgeon may assist a doctor of podiatric medicine who is a partner, shareholder, or employee in the same medical group as the supervising physician and surgeon. A physician assistant who assists a doctor of podiatric medicine pursuant to this subdivision shall do so only according to patient-specific orders from the supervising physician and surgeon.

(2)The supervising physician and surgeon shall be physically available to the physician assistant for consultation when that assistance is rendered. A physician assistant assisting a doctor of podiatric medicine shall be limited to performing those duties included within the scope of practice of a doctor of podiatric medicine.

(c)(1)A physician assistant and his or her supervising physician and surgeon shall establish written guidelines for the adequate supervision of the physician assistant. This requirement may be satisfied by the supervising physician and surgeon adopting protocols for some or all of the tasks performed by the physician assistant. The protocols adopted pursuant to this subdivision shall comply with the following requirements:

(A)A protocol governing diagnosis and management shall, at a minimum, include the presence or absence of symptoms, signs, and other data necessary to establish a diagnosis or assessment, any appropriate tests or studies to order, drugs to recommend to the patient, and education to be provided to the patient.

(B)A protocol governing procedures shall set forth the information to be provided to the patient, the nature of the consent to be obtained from the patient, the preparation and technique of the procedure, and the followup care.

(C)Protocols shall be developed by the supervising physician and surgeon or adopted from, or referenced to, texts or other sources.

(D)Protocols shall be signed and dated by the supervising physician and surgeon and the physician assistant.

(2)(A)The supervising physician and surgeon shall use one or more of the following mechanisms to ensure adequate supervision of the physician assistant functioning under the protocols:

(i)The supervising physician and surgeon shall review, countersign, and date a sample consisting of, at a minimum, 5 percent of the medical records of patients treated by the physician assistant functioning under the protocols within 30 days of the date of treatment by the physician assistant.

(ii)The supervising physician and surgeon and physician assistant shall conduct a medical records review meeting at least once a month during at least 10 months of the year. During any month in which a medical records review meeting occurs, the supervising physician and surgeon and physician assistant shall review an aggregate of at least 10 medical records of patients treated by the physician assistant functioning under protocols. Documentation of medical records reviewed during the month shall be jointly signed and dated by the supervising physician and surgeon and the physician assistant.

(iii)The supervising physician and surgeon shall review a sample of at least 10 medical records per month, at least 10 months during the year, using a combination of the countersignature mechanism described in clause (i) and the medical records review meeting mechanism described in clause (ii). During each month for which a sample is reviewed, at least one of the medical records in the sample shall be reviewed using the mechanism described in clause (i) and at least one of the medical records in the sample shall be reviewed using the mechanism described in clause (ii).

(B)In complying with subparagraph (A), the supervising physician and surgeon shall select for review those cases that by diagnosis, problem, treatment, or procedure represent, in his or her judgment, the most significant risk to the patient.

(3)Notwithstanding any other law, the Medical Board of California or the board may establish other alternative mechanisms for the adequate supervision of the physician assistant.

(2) Medical services provided by a PA shall be commensurate with the PA’s skills, education, and training. This includes, but is not limited to, any of the following:

(A) Obtaining and performing comprehensive health histories and physical examinations.

(B) Evaluating, diagnosing, managing, and providing medical treatment.

(C) Ordering, performing, and interpreting diagnostic studies and therapeutic procedures.

(D) Making calls or going on rounds in private homes, public institutions, emergency vehicles, ambulatory care clinics, hospitals, intermediate or extended care facilities, health maintenance organizations, nursing homes, or other health care facilities.

(E) Educating patients on health promotion and disease prevention.

(F) Performing surgical procedures that are customarily performed under local anesthesia or other forms of sedation that allow a patient to maintain the patient’s own airway, and act as first or second assistant in surgery requiring other forms of anesthesia.

(G) Providing consultation upon request and making referrals to other health care practitioners.

(H) Writing medical orders.

(I) Obtaining informed consent.

(J) The supervision, delegation, and assignment of therapeutic and diagnostic measures to licensed or unlicensed personnel.

(K) Certifying the health or disability of a patient as required by any local, state, or federal program.

(L) Authenticate any document with the PA’s signature, certification, stamp, verification, affidavit, or endorsement if the document may be authenticated by the signature, certification, stamp, verification, affidavit, or endorsement of a physician and surgeon. A physician and surgeon shall not be required to sign an official form that lists the physician and surgeon’s signature as the required signatory if that official form is signed by a PA.

(M) Prescribe, dispense, order, administer, and procure drugs and medical devices pursuant to Section 3502.1.

(N) Plan and initiate a therapeutic regimen that includes ordering and prescribing nonpharmacological interventions, including, but not limited to, durable medical equipment, nutrition, blood and blood products, and diagnostic support services, which include, but are not limited to, nursing, home health care, hospice, and physical and occupational therapy.

(b) A PA is authorized to bill for and receive direct payment for the medical services the PA provides.

(1) Payment for services within a PA’s scope of practice shall be made when ordered or performed by a PA, if the same service would have been covered if ordered or performed by a physician and surgeon.

(2) To ensure accountability and transparency for patients, payers, and the health care system, a PA shall be identified as the rendering professional in the billing and claims process when a PA delivers medical or surgical services to a patient.

(3) An insurance company, state governmental payer, or third-party payer shall not impose a practice, education, payment, or supervision requirement that is inconsistent with, or more restrictive than, this chapter or regulations issued pursuant to this chapter or that discriminates against legally qualified PAs based solely on their license.

(4) To facilitate more flexible employment arrangements, including, but not limited to, when a PA works with a staffing company or in a medical group structure, the PA may reassign the PA’s direct payment to the PA’s employer.

(c) A PA shall practice and collaborate in accordance with the practice agreement or an organized health care practice setting’s established internal processes, by consulting with or referring to, or both, the appropriate member or members of a health care team as indicated by the patient’s condition. This shall be done in a manner consistent with the education, training, experience, and competencies of the PA and the standard of care. A PA shall refer a patient to a physician and surgeon or other licensed health care provider if a situation or condition of the patient is beyond the scope of the education and training of the PA.

(d) (1) The degree of collaboration shall be outlined in the practice agreement, which shall be signed by both the PA and one or more physicians and surgeons and kept on file at the practice location. The practice agreement shall contain all of the following:

(A) The agreed upon process to ensure adequate communication, availability, and consultation between the physician and surgeon and PA in the provision of medical services to patients. This process should be customized based on the knowledge and skills of the PA and physician and surgeon consistent with their education, training, and experience.

(B) Patient referral and consultation.

(C) Emergency coverage for absences of a PA, including another PA or physician and surgeon.

(D) Methods for the continuing evaluation of the competency and qualifications of the PA.

(E) Guidelines for prescriptions.

(F) Any additional provisions, as agreed to by the PA and physician and surgeon.

(2) Any reference to “protocols” or “delegation of services agreement” in any law or regulation that references this chapter shall have the same meaning as “practice agreement,” as defined in Section 3501, or the established internal process for collaboration in any of the organized healthcare practice settings described in subdivision (e).

(e) (1) Notwithstanding subdivision (d), a PA providing medical services in one of the organized health care practice settings in paragraph (2) is exempt from the requirement to execute a practice agreement under subdivision (d) and instead shall collaborate utilizing the practice setting’s established internal process for determining the role and responsibilities for the PA based on the PA’s training, experience, qualifications, and competency.

(2) Paragraph (1) applies to any of the following:

(A) A clinic as described in Chapter 1 (commencing with Section 1200) of Division 2 of the Health and Safety Code.

(B) A facility as described in Chapter 2 (commencing with Section 1250) of Division 2 of the Health and Safety Code.

(C) A facility as described in Chapter 2.5 (commencing with Section 1440) of Division 2 of the Health and Safety Code.

(D) An accountable care organization, as defined in Section 3022 of the federal Patient Protection and Affordable Care Act (Public Law 111-148) (42 U.S.C. Sec. 1395jjj).

(E) A group practice, including a professional medical corporation, another form of corporation controlled by physicians and surgeons, a medical partnership, a medical foundation exempt from licensure, or another lawfully organized group of physicians and surgeons that delivers, furnishes, or otherwise arranges for or provides health care services.

(F) A medical group, independent practice association, or any similar association.

(f) A PA practicing under this section shall adhere to professional standards and shall be responsible for any breaches in adherence to a practice agreement or an organized health care practice setting’s internal processes as provided in subdivision (e).

(d)

(g) No medical services may be performed under this chapter in any of the following areas:

(1) The determination of the refractive states of the human eye, or the fitting or adaptation of lenses or frames for the aid thereof.

(2) The prescribing or directing the use of, or using, any optical device in connection with ocular exercises, visual training, or orthoptics.

(3) The prescribing of contact lenses for, or the fitting or adaptation of contact lenses to, the human eye.

(4) The practice of dentistry or dental hygiene or the work of a dental auxiliary as defined in Chapter 4 (commencing with Section 1600).

(e)

(h) This section shall not be construed in a manner that shall preclude the performance of routine visual screening as defined in Section 3501.

(f)

(i) Compliance by a physician assistant and supervising physician and surgeon PA with this section shall be deemed compliance with Section 1399.546 of Title 16 of the California Code of Regulations.

SEC. 4.

 Section 3502.1 of the Business and Professions Code is amended to read:

3502.1.

 (a) In addition to the services authorized in the regulations adopted by the Medical Board of California, and except as prohibited by Section 3502, while under the supervision of a licensed physician and surgeon or physicians and surgeons authorized by law to supervise a physician assistant, a physician assistant may administer or provide medication to a patient, or transmit orally, or in writing on a patient’s record or in a drug order, an order Pursuant to the services authorized in Section 3502, unless otherwise prohibited by law, a PA may prescribe, dispense, order, administer, and procure drugs and medical devices to a patient or person who may lawfully furnish the medication or medical device pursuant to subdivisions (c) and (d). A PA may plan and initiate a therapeutic regimen that includes ordering and prescribing nonpharmacological interventions, including, but not limited to, durable medical equipment, nutrition, blood and blood products, and diagnostic support services, which include, but are not limited to, home health care, hospice, and physical and occupational therapy.

(1)A supervising physician and surgeon who delegates authority to issue a drug order to a physician assistant may limit this authority by specifying the manner in which the physician assistant may issue delegated prescriptions.

(2)Each supervising physician and surgeon who delegates the authority to issue a drug order to a physician assistant shall first prepare and adopt, or adopt, a written, practice specific, formulary and protocols that specify all criteria for the use of a particular drug or device, and any contraindications for the selection. Protocols for Schedule II controlled substances shall address the diagnosis of illness, injury, or condition for which the Schedule II controlled substance is being administered, provided, or issued. The drugs listed in the protocols shall constitute the formulary and shall include only drugs that are appropriate for use in the type of practice engaged in by the supervising physician and surgeon. When issuing a drug order, the physician assistant is acting on behalf of and as an agent for a supervising physician and surgeon.

(b) “Drug order,” “Prescription,” for purposes of this section, means an order for medication that is dispensed to or for a patient, issued and signed by a physician assistant PA acting as an individual practitioner within the meaning of Section 1306.02 of Title 21 of the Code of Federal Regulations. Notwithstanding any other provision of law, (1) a drug order issued pursuant to this section shall be treated in the same manner as a prescription or order of the supervising physician, (2) all references to “prescription” in this code and code, the Health and Safety Code Code, or any other section of law shall include drug orders any prescription issued by physician assistants pursuant to authority granted by their supervising physicians and surgeons, and (3) a PA, and the signature of a physician assistant PA on a drug order prescription shall be deemed to be the signature of a prescriber for purposes of this code and the Health and Safety Code.

(c)A drug order for any patient cared for by the physician assistant that is issued by the physician assistant shall either be based on the protocols described in subdivision (a) or shall be approved by the supervising physician and surgeon before it is filled or carried out.

(1)A physician assistant shall not administer or provide a drug or issue a drug order for a drug other than for a drug listed in the formulary without advance approval from a supervising physician and surgeon for the particular patient. At the direction and under the supervision of a physician and surgeon, a physician assistant may hand to a patient of the supervising physician and surgeon a properly labeled prescription drug prepackaged by a physician and surgeon, manufacturer as defined in the Pharmacy Law, or a pharmacist.

(2)A physician assistant

(c) (1) A PA shall not administer, provide, or issue a drug order prescription to a patient for Schedule II through Schedule V controlled substances without advance approval by a supervising physician and surgeon for that particular patient unless the physician assistant PA has completed evidence of completing an education course that covers controlled substances and that meets standards, including pharmacological content, approved by the board. The education course shall be provided either by an accredited continuing education provider or by an approved physician assistant PA training program. If the physician assistant PA will administer, provide, or issue a drug order for Schedule II controlled substances, the course shall contain a minimum of three hours exclusively on Schedule II controlled substances, including the risks of addiction associated with their use. Completion of the requirements set forth in this paragraph shall be verified and documented in the manner established by the board prior to the physician assistant’s PA’s use of a registration number issued by the United States Drug Enforcement Administration to the physician assistant to administer, provide, or issue a drug order to a patient for a controlled substance without advance approval by a supervising physician and surgeon for that particular patient. Administration.

(3)

(2) Any drug order prescription issued by a physician assistant PA shall be subject to a reasonable quantitative limitation consistent with customary medical practice in the supervising physician and surgeon’s practice.

(d) A written drug order prescription issued pursuant to subdivision (a), except for a written drug order in a patient’s medical record in a health facility or medical practice, shall contain the printed name, address, and telephone number of the supervising physician and surgeon, the printed or stamped name number, and license number of the physician assistant, PA, and the signature of the physician assistant. PA. Further, a written drug order prescription for a controlled substance, except for a written drug order in a patient’s medical record in a health facility or a medical practice, shall include the federal controlled substances registration number of the physician assistant PA and shall otherwise comply with Section 11162.1 of the Health and Safety Code. Except as otherwise required for written drug orders prescriptions for controlled substances under Section 11162.1 of the Health and Safety Code, the requirements of this subdivision may be met through stamping or otherwise imprinting on the supervising physician and surgeon’s prescription blank to show the name, license number, and if applicable, the federal controlled substances registration number of the physician assistant, PA, and shall be signed by the physician assistant. When using a drug order, the physician assistant is acting on behalf of and as the agent of a supervising physician and surgeon. PA.

(e)The supervising physician and surgeon shall use either of the following mechanisms to ensure adequate supervision of the administration, provision, or issuance by a physician assistant of a drug order to a patient for Schedule II controlled substances:

(1)The medical record of any patient cared for by a physician assistant for whom the physician assistant’s Schedule II drug order has been issued or carried out shall be reviewed, countersigned, and dated by a supervising physician and surgeon within seven days.

(2)If the physician assistant has documentation evidencing the successful completion of an education course that covers controlled substances, and that controlled substance education course (A) meets the standards, including pharmacological content, established in Sections 1399.610 and 1399.612 of Title 16 of the California Code of Regulations, and (B) is provided either by an accredited continuing education provider or by an approved physician assistant training program, the supervising physician and surgeon shall review, countersign, and date, within seven days, a sample consisting of the medical records of at least 20 percent of the patients cared for by the physician assistant for whom the physician assistant’s Schedule II drug order has been issued or carried out. Completion of the requirements set forth in this paragraph shall be verified and documented in the manner established in Section 1399.612 of Title 16 of the California Code of Regulations. Physician assistants who have a certificate of completion of the course described in paragraph (2) of subdivision (c) shall be deemed to have met the education course requirement of this subdivision.

(f)All physician assistants who are authorized by their supervising physicians to issue drug orders for controlled substances shall register with the United States Drug Enforcement Administration (DEA).

(g)The board shall consult with the Medical Board of California and report during its sunset review required by Article 7.5 (commencing with Section 9147.7) of Chapter 1.5 of Part 1 of Division 2 of Title 2 of the Government Code the impacts of exempting Schedule III and Schedule IV drug orders from the requirement for a physician and surgeon to review and countersign the affected medical record of a patient.

SEC. 5.

 Section 3502.3 of the Business and Professions Code is amended to read:

3502.3.

 (a)Notwithstanding any other provision of law, in addition to any other practices that meet the general criteria set forth in this chapter or the Medical Board of California’s board’s regulations for inclusion in a delegation of services agreement, a delegation of services agreement may authorize a physician assistant to practice agreement or organized health care practice setting’s internal process for determining the role and responsibilities for a PA based on the PA’s training, experience, qualifications, and competency, a PA may do any of the following:

(1)

(a) Order durable medical equipment, subject to any limitations set forth in Section 3502 or the delegation of services agreement. 3502. Notwithstanding that authority, nothing in this paragraph shall operate to limit the ability of a third-party payer to require prior approval.

(2)

(b) For individuals receiving home health services or personal care services, after consultation with the supervising physician, approve, sign, modify, or add to a plan of treatment or plan of care.

(3)

(c) After performance of a physical examination by the physician assistant under the supervision of a physician and surgeon consistent with this chapter, PA, certify disability pursuant to Section 2708 of the Unemployment Insurance Code. The Employment Development Department shall implement this paragraph on or before January 1, 2017.

(b)Nothing in this section shall be construed to affect the validity of any delegation of services agreement in effect prior to the enactment of this section or those adopted subsequent to enactment.

SEC. 6.

 Section 3502.5 of the Business and Professions Code is amended to read:

3502.5.

 (a) Notwithstanding any other provision of law, a physician assistant may perform those medical services permitted pursuant to Section 3502 during any state of war emergency, state of emergency, or state of local emergency, as defined in Section 8558 of the Government Code, and at the request of a responsible federal, state, or local official or agency, or pursuant to the terms of a mutual aid operation plan established and approved pursuant to the California Emergency Services Act (Chapter 7 (commencing with Section 8550) of Division 1 of Title 2 of the Government Code), regardless of whether the physician assistant’s approved supervising physician is available to supervise the physician assistant, so long as a licensed physician is available to render the appropriate supervision. “Appropriate supervision” shall not require the personal or electronic availability of a supervising physician if that availability is not possible or practical due to the emergency. The local health officers and their designees may act as supervising physicians during emergencies without being subject to approval by the Medical Board of California. At all times, the local health officers or their designees supervising the physician assistants shall be licensed physicians and surgeons. Supervising physicians acting pursuant to this section shall not be subject to the limitation on the number of physician assistants supervised under Section 3516. Code).

No

(b) A responsible official or mutual aid operation plan shall not invoke this section section, except in the case of an emergency that endangers the health of individuals. Under no circumstances shall this section be invoked as the result of a labor dispute or other dispute concerning collective bargaining.

SEC. 7.

 Section 3504 of the Business and Professions Code is amended to read:

3504.

 There is established a the Physician Assistant Board of California within the jurisdiction of the Medical Board of California. Department of Consumer Affairs. The board consists of nine members. This section shall remain in effect only until January 1, 2021, and as of that date is repealed. Notwithstanding any other law, the repeal of this section renders the board subject to review by the appropriate policy committees of the Legislature.

SEC. 8.

 Section 3509 of the Business and Professions Code is amended to read:

3509.

 It shall be the duty of the board to: to both:

(a) Establish standards and issue licenses of approval for programs for the education and training of physician assistants. PAs.

(b)Make recommendations to the Medical Board of California concerning the scope of practice for physician assistants.

(c)Make recommendations to the Medical Board of California concerning the formulation of guidelines for the consideration of applications by licensed physicians to supervise physician assistants and approval of such applications.

(d)

(b) Require the examination of applicants for licensure as a physician assistant PA who meet the requirements of this chapter.

SEC. 9.

 Section 3516 of the Business and Professions Code is repealed.

3516.

(a)Notwithstanding any other provision of law, a physician assistant licensed by the board shall be eligible for employment or supervision by any physician and surgeon who is not subject to a disciplinary condition imposed by the Medical Board of California prohibiting that employment or supervision.

(b)No physician and surgeon shall supervise more than four physician assistants at any one time, except as provided in Section 3502.5.

(c)The Medical Board of California may restrict a physician and surgeon to supervising specific types of physician assistants including, but not limited to, restricting a physician and surgeon from supervising physician assistants outside of the field of specialty of the physician and surgeon.

SEC. 10.

 Section 3516.5 of the Business and Professions Code is repealed.

3516.5.

(a)Notwithstanding any other provision of law and in accordance with regulations established by the Medical Board of California, the director of emergency care services in a hospital with an approved program for the training of emergency care physician assistants, may apply to the Medical Board of California for authorization under which the director may grant approval for emergency care physicians on the staff of the hospital to supervise emergency care physician assistants.

(b)The application shall encompass all supervising physicians employed in that service.

(c)Nothing in this section shall be construed to authorize any one emergency care physician while on duty to supervise more than four physician assistants at any one time.

(d)A violation of this section by the director of emergency care services in a hospital with an approved program for the training of emergency care physician assistants constitutes unprofessional conduct within the meaning of Chapter 5 (commencing with Section 2000).

(e)A violation of this section shall be grounds for suspension of the approval of the director or disciplinary action against the director or suspension of the approved program under Section 3527.

SEC. 11.

 Section 3517 of the Business and Professions Code is amended to read:

3517.

 (a) The board shall require a written examination of physician assistants a PA in the manner and under the rules and regulations as it shall prescribe, but the examination shall be conducted in that manner as to ensure that the identity of each applicant taking the examination will be unknown to all of the examiners until all examination papers have been graded. Except as otherwise provided in this chapter, or by regulation, no physician assistant a PA applicant shall not receive approval under this chapter without first successfully passing an examination given under the direction of the board.

Examinations

(b) Examinations for licensure as a physician assistant PA may be required by the board under a uniform examination system, and for that purpose the board may make those arrangements with organizations furnishing examination material as may, in its discretion, be desirable. The board shall, however, establish a passing score for each examination. The licensure examination for physician assistants shall be held by the board at least once a year with such additional examinations as the board deems necessary. The time and place of examination shall be fixed by the board.

SEC. 12.

 Section 3518 of the Business and Professions Code is amended to read:

3518.

 The board shall keep current, two separate registers, one for approved supervising physicians and one a current register for licensed physician assistants, PAs, by specialty if applicable. These registers shall show the name of each licensee, his or her the licensee’s last known address of record, and the date of his or her licensure or approval. the licensee’s licensure. Any interested person is entitled to obtain a copy of the register in accordance with the Information Practices Act of 1977 (Chapter 1 (commencing with Section 1798) of Title 1.8 of Part 4 of Division 3 of the Civil Code) upon application to the board together with a sum as may be fixed by the board, which amount shall not exceed the cost of this list so furnished.

SEC. 13.

 Section 3519 of the Business and Professions Code is amended to read:

3519.

 The board shall issue under the its name of the Medical Board of California a license to all physician assistant PA applicants who meet all of the following requirements:

(a) Provide evidence of successful completion of an approved program.

(b) Pass any examination required under Section 3517.

(c) Not be subject to denial of licensure under Division 1.5 (commencing with Section 475) or Section 3527.

(d) Pay all fees required under Section 3521.1.

SEC. 14.

 Section 3519.5 of the Business and Professions Code is amended to read:

3519.5.

 (a) The board may issue under the its name of the Medical Board of California a probationary license to an applicant subject to terms and conditions, including, but not limited to, any of the following conditions of probation:

(1) Practice limited to a supervised, structured environment where the applicant’s activities shall be supervised by another physician assistant. PA.

(2) Total or partial restrictions on issuing a drug order for controlled substances.

(3) Continuing medical or psychiatric treatment.

(4) Ongoing participation in a specified rehabilitation program.

(5) Enrollment and successful completion of a clinical training program.

(6) Abstention from the use of alcohol or drugs.

(7) Restrictions against engaging in certain types of medical services.

(8) Compliance with all provisions of this chapter.

(b) The board and the Medical Board of California may modify or terminate the terms and conditions imposed on the probationary license upon receipt of a petition from the licensee.

(c) Enforcement and monitoring of the probationary conditions shall be under the jurisdiction of the board and the Medical Board of California. board. These proceedings shall be conducted in accordance with Chapter 5 (commencing with Section 11500) of Part 1 of Division 3 of Title 2 of the Government Code.

SEC. 15.

 Section 3521 of the Business and Professions Code is repealed.

3521.

The fees to be paid for approval to supervise physician assistants are to be set by the board as follows:

(a)An application fee not to exceed fifty dollars ($50) shall be charged to each physician and surgeon applicant.

(b)An approval fee not to exceed two hundred fifty dollars ($250) shall be charged to each physician and surgeon upon approval of an application to supervise physician assistants.

(c)A biennial renewal fee not to exceed three hundred dollars ($300) shall be paid for the renewal of an approval.

(d)The delinquency fee is twenty-five dollars ($25).

(e)The duplicate approval fee is ten dollars ($10).

(f)The fee for a letter of endorsement, letter of good standing, or letter of verification of approval shall be ten dollars ($10).

SEC. 16.

 Section 3522 of the Business and Professions Code is repealed.

3522.

An approval to supervise physician assistants shall expire at 12 midnight on the last day of the birth month of the physician and surgeon during the second year of a two-year term if not renewed.

The Medical Board of California shall establish a cyclical renewal program, including, but not limited to, the establishment of a system of staggered expiration dates for approvals and a pro rata formula for the payment of renewal fees by physician and surgeon supervisors.

To renew an unexpired approval, the approved supervising physician and surgeon, on or before the date of expiration, shall apply for renewal on a form prescribed by the Medical Board of California and pay the prescribed renewal fee.

SEC. 17.

 Section 3524 of the Business and Professions Code is amended to read:

3524.

 A license or approval that has expired may be renewed at any time within five years after its expiration by filing an application for renewal on a form prescribed by the board or Medical Board of California, as the case may be, and payment of all accrued and unpaid renewal fees. If the license or approval is not renewed within 30 days after its expiration, the licensed physician assistant and approved supervising physician, PA, as a condition precedent to renewal, shall also pay the prescribed delinquency fee, if any. Renewal under this section shall be effective on the date on which the application is filed, on the date on which all renewal fees are paid, or on the date on which the delinquency fee, if any, is paid, whichever occurs last. If so renewed, the license shall continue in effect through the expiration date provided in Section 3522 or 3523 which next occurs after the effective date of the renewal, when it shall expire, if it is not again renewed.

SEC. 18.

 Section 3527 of the Business and Professions Code is amended to read:

3527.

 (a) The board may order the denial of an application for, or the issuance subject to terms and conditions of, or the suspension or revocation of, or the imposition of probationary conditions upon a physician assistant PA license after a hearing as required in Section 3528 for unprofessional conduct that includes, but is not limited to, a violation of this chapter, a violation of the Medical Practice Act, or a violation of the regulations adopted by the board or the Medical Board of California. chapter.

(b) The board may order the denial of an application for, or the suspension or revocation of, or the imposition of probationary conditions upon, an approved program after a hearing as required in Section 3528 for a violation of this chapter or the regulations adopted pursuant thereto.

(c)The Medical Board of California may order the denial of an application for, or the issuance subject to terms and conditions of, or the suspension or revocation of, or the imposition of probationary conditions upon, an approval to supervise a physician assistant, after a hearing as required in Section 3528, for unprofessional conduct, which includes, but is not limited to, a violation of this chapter, a violation of the Medical Practice Act, or a violation of the regulations adopted by the board or the Medical Board of California.

(d)Notwithstanding subdivision (c), the Division of Medical Quality of the Medical Board of California, in conjunction with an action it has commenced against a physician and surgeon, may, in its own discretion and without the concurrence of the Medical Board of California, order the suspension or revocation of, or the imposition of probationary conditions upon, an approval to supervise a physician assistant, after a hearing as required in Section 3528, for unprofessional conduct, which includes, but is not limited to, a violation of this chapter, a violation of the Medical Practice Act, or a violation of the regulations adopted by the board or the Medical Board of California.

(e)

(c) The board may order the denial of an application for, or the suspension or revocation of, or the imposition of probationary conditions upon, a physician assistant PA license, after a hearing as required in Section 3528 for unprofessional conduct that includes, except for good cause, the knowing failure of a licensee to protect patients by failing to follow infection control guidelines of the board, thereby risking transmission of bloodborne infectious diseases from licensee to patient, from patient to patient, and from patient to licensee. In administering this subdivision, the board shall consider referencing the standards, regulations, and guidelines of the State Department of Public Health developed pursuant to Section 1250.11 of the Health and Safety Code and the standards, regulations, and guidelines pursuant to the California Occupational Safety and Health Act of 1973 (Part 1 (commencing with Section 6300) of Division 5 of the Labor Code) for preventing the transmission of HIV, hepatitis B, and other bloodborne pathogens in health care settings. As necessary, the board shall consult with the Medical Board of California, the Board of Podiatric Medicine, Podiatric Medical Board of California, the Board of Dental Examiners, the Board of Registered Nursing, and the Board of Vocational Nursing and Psychiatric Technicians, to encourage appropriate consistency in the implementation of this subdivision.

The board shall seek to ensure that licensees are informed of the responsibility of licensees and others to follow infection control guidelines, and of the most recent scientifically recognized safeguards for minimizing the risk of transmission of blood-borne infectious diseases.

(f)

(d) The board may order the licensee to pay the costs of monitoring the probationary conditions imposed on the license.

(g)

(e) The expiration, cancellation, forfeiture, or suspension of a physician assistant PA license by operation of law or by order or decision of the board or a court of law, the placement of a license on a retired status, or the voluntary surrender of a license by a licensee shall not deprive the board of jurisdiction to commence or proceed with any investigation of, or action or disciplinary proceeding against, the licensee or to render a decision suspending or revoking the license.

SEC. 19.

 Section 3528 of the Business and Professions Code is amended to read:

3528.

 Any proceedings involving the denial, suspension, or revocation of the application for licensure or the license of a physician assistant, the application for approval or the approval of a supervising physician, PA or the application for approval or the approval of an approved program under this chapter shall be conducted in accordance with Chapter 5 (commencing with Section 11500) of Part 1 of Division 3 of Title 2 of the Government Code.

SEC. 20.

 Section 3530 of the Business and Professions Code is amended to read:

3530.

 (a) A person whose license or approval has been revoked or suspended, or who has been placed on probation, may petition the board for reinstatement or modification of penalty, including modification or termination of probation, after a period of not less than the following minimum periods has elapsed from the effective date of the decision ordering that disciplinary action:

(1) At least three years for reinstatement of a license or approval revoked for unprofessional conduct, except that the board may, for good cause shown, specify in a revocation order that a petition for reinstatement may be filed after two years.

(2) At least two years for early termination of probation of three years or more.

(3) At least one year for modification of a condition, or reinstatement of a license or approval revoked for mental or physical illness, or termination of probation of less than three years.

(b)The petition shall state any facts as may be required by the Medical Board of California. The petition shall be accompanied by at least two verified recommendations from physicians licensed either by the Medical Board of California or the Osteopathic Medical Board who have personal knowledge of the activities of the petitioner since the disciplinary penalty was imposed.

(c)

(b) The petition may be heard by the board. The board may assign the petition to an administrative law judge designated in Section 11371 of the Government Code. After a hearing on the petition, the administrative law judge shall provide a proposed decision to the board that shall be acted upon in accordance with the Administrative Procedure Act.

(d)

(c) The board or the administrative law judge hearing the petition, may consider all activities of the petitioner since the disciplinary action was taken, the offense for which the petitioner was disciplined, the petitioner’s activities during the time the license was in good standing, and the petitioner’s rehabilitative efforts, general reputation for truth, and professional ability. The hearing may be continued, as the board or administrative law judge finds necessary.

(e)

(d) The board or administrative law judge, when hearing a petition for reinstating a license or approval or modifying a penalty, may recommend the imposition of any terms and conditions deemed necessary.

(f)No

(e) A petition shall not be considered while the petitioner is under sentence for any criminal offense, including any period during which the petitioner is on court-imposed probation or parole. No A petition shall not be considered while there is an accusation or petition to revoke probation pending against the person. The board may deny, without a hearing or argument, any petition filed pursuant to this section within a period of two years from the effective date of the prior decision following a hearing under this section.

(g)

(f) Nothing in this section shall be deemed to alter Sections 822 and 823.

SEC. 21.

 Section 3535 of the Business and Professions Code is amended to read:

3535.

 (a) Notwithstanding any other provision of law, physicians and surgeons licensed by the Osteopathic Medical Board of California may use or employ physician assistants collaborate with PAs provided (1) each physician assistant so used or employed PA is a graduate of an approved program and is licensed by the board, and (2) the scope of practice of the physician assistant is the same as that which is approved by the Division of Licensing of the Medical Board of California for physicians and surgeons supervising physician assistants in the same or similar specialty. the practice of the PA is consistent with this chapter.

(b) Any person who violates subdivision (a) shall be guilty of a misdemeanor punishable by imprisonment in a county jail not exceeding six months, or by a fine not exceeding one thousand dollars ($1,000), or by both that imprisonment and fine.

(c) This section shall become operative on July 1, 2001.

SEC. 22.

 The provisions of this measure are severable. If any provision of this measure or its application is held invalid, that invalidity shall not affect other provisions or applications that can be given effect without the invalid provision or application.

SEC. 23.

 No reimbursement is required by this act pursuant to Section 6 of Article XIII B of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIII B of the California Constitution.