Bill Text: HI HB1813 | 2018 | Regular Session | Amended
Bill Title: Relating To Health.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2018-02-16 - Passed Second Reading as amended in HD 2 and referred to the committee(s) on FIN with none voting aye with reservations; none voting no (0) and Representative(s) DeCoite, Ing, Nakamura, Onishi, Woodson excused (5). [HB1813 Detail]
Download: Hawaii-2018-HB1813-Amended.html
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HOUSE OF REPRESENTATIVES |
H.B. NO. |
1813 |
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TWENTY-NINTH LEGISLATURE, 2018 |
H.D. 1 |
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STATE OF HAWAII |
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A BILL FOR AN ACT
RELATING TO HEALTH.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
SECTION 1. The legislature finds that there is a shortage of doctors who are available to provide healthcare, despite the rising number of medical school graduates. According to a 2017 report by the Association of American Medical Colleges, medical school enrollment has increased twenty-five per cent to nearly 87,000 students nationally since 2002. However, medical school graduates are struggling to be accepted into the residency programs that they need to become accredited physicians. In 2015, the National Resident Matching Program found that 41,334 applicants applied for 30,312 residency positions.
The legislature further finds that several states, including Missouri, Arkansas, Kansas, and Utah, have enacted legislation that address the doctor shortage by creating a new category of licensed professionals, called assistant physicians, for recent medical school graduates who have passed certain medical exams but have not been placed into a residency program. The assistant physician license allows medical schools graduates to work under the supervision of a licensed physician to provide primary care in medically underserved areas. These laws aim to connect physicians in need of jobs with communities in need of physicians.
The purpose of this Act is to establish a three-year pilot program to increase the number of providers of medical services by creating a new category of professional licensure for assistant physicians.
SECTION 2. Chapter 453, Hawaii Revised Statutes, is amended by adding a new part to be appropriately designated and to read as follows:
"PART . ASSISTANT PHYSICIANS
§453- Definitions. Whenever used in this part, unless a different meaning clearly appears from the context:
"Assistant physician" means any medical school graduate who:
(1) Is a resident and citizen of the United States or is a legal resident alien;
(2) Has successfully completed Step 1 and Step 2 of the United States Medical Licensing Examination or the equivalent of such step of any other board-approved medical licensing examination within the four-year period immediately preceding application for licensure as an assistant physician, but in no event more than four years after graduation from a medical college or osteopathic medical college;
(3) Has not completed an approved postgraduate residency and has successfully completed Step 2 of the United States Medical Licensing Examination or the equivalent of such step of any other board-approved medical licensing examination within the immediately preceding four-year period unless when such four-year anniversary occurred the graduate was serving as a resident physician in an accredited residency in the United States and continued to do so within thirty days prior to application for licensure as an assistant physician; and
(4) Has proficiency in the English language.
“Assistant physician collaborative practice arrangement” means an agreement between a physician and an assistant physician that meets the requirements of this part.
“Medical school graduate” means any person who has graduated from a medical college or osteopathic medical college.
§453- Assistant physicians. (a) Any medical school graduate who meets the criteria for licensure pursuant to this part may apply for licensure.
(b) An assistant physician collaborative practice arrangement shall limit the assistant physician to providing primary care services in medically underserved rural or urban areas of this State, in health care facilities with internship or residency training programs, or in pilot project areas established in which assistant physicians may practice.
(c) For an assistant physician working in a rural health clinic under the federal Rural Health Clinic Services Act, Public Law section 95-210, as amended:
(1) An assistant physician shall be considered a physician assistant for purposes of regulations of the Centers for Medicare and Medicaid Services; and
(2) No supervision requirements in addition to the minimum federal law shall be required.
(d) An assistant physician shall be considered a physician assistant for insurance reimbursement purposes. The department of human services shall seek any necessary waivers or state medicaid plan amendments to implement the reimbursement provisions of this part.
(e) For purposes of this part, the licensure of assistant physicians shall take place within processes established by rules of the Hawaii medical board. The board shall adopt rules pursuant to chapter 91 to establish licensure and renewal procedures, supervision requirements, collaborative practice arrangements, fees, and such other matters as are necessary to protect the public and discipline the profession. No licensure fee for an assistant physician shall exceed the amount of any licensure fee for a physician assistant.
(f) An application for licensure may be denied or the licensure of an assistant physician may be suspended or revoked by the board in the same manner and for violation of the standards of conduct set by the board by rule. No rule adopted by the board shall require an assistant physician to complete more hours of continuing medical education than that of a licensed physician.
(g) An assistant physician shall be clearly identified as an assistant physician and shall be permitted to use the terms “doctor”, “Dr.”, or “doc”. No assistant physician shall practice or attempt to practice without an assistant physician collaborative practice arrangement, except as otherwise provided in this part or in an emergency situation.
(h) The collaborating physician shall be responsible at all times for the oversight of the activities of and accept responsibility for services rendered by the assistant physician.
(i) The director of health or the director's designee may collaborate with any number of assistant physicians for the treatment of substance abuse disorders.
(j) Each health carrier or health benefit plan that offers or issues health benefit plans that are delivered, issued for delivery, continued, or renewed in the State shall reimburse an assistant physician for the diagnosis, consultation, or treatment of an insured or enrollee on the same basis that the health carrier or health benefit plan covers the service when it is delivered by another comparable mid-level health care provider including, but not limited to, a physician assistant.
(k) A physician may enter into collaborative practice arrangements with assistant physicians. Collaborative practice arrangements shall be in the form of written agreements, jointly agreed-upon protocols, or standing orders for the delivery of health care services. Collaborative practice arrangements, which shall be in writing, may delegate to an assistant physician the authority to administer or dispense drugs and provide treatment as long as the delivery of such health care services is within the scope of practice of the assistant physician and is consistent with that assistant physician's skill, training, and competence and the skill and training of the collaborating physician.
(l) The written collaborative practice arrangement shall contain at least the following provisions:
(1) Complete names, home and business addresses, zip codes, and telephone numbers of the collaborating physician and the assistant physician;
(2) A list of all other offices or locations where the collaborating physician has authorized the assistant physician to practice;
(3) A requirement that there shall be posted at every office where the assistant physician is authorized to practice, in collaboration with a physician, a prominently displayed disclosure statement informing patients that they may be seen by an assistant physician and have the right to see the collaborating physician;
(4) All specialty or board certifications of the collaborating physician and all certifications of the assistant physician;
(5) The manner of collaboration between the collaborating physician and the assistant physician, including the methods in which the collaborating physician and the assistant physician shall:
(A) Engage in collaborative practice consistent with each professional's skill, training, education, and competence;
(B) Maintain geographic proximity; except, the collaborative practice arrangement may allow for geographic proximity to be waived for a maximum of twenty-eight days per calendar year for rural health clinics as defined by Public Law section 95-210, as amended, as long as the collaborative practice arrangement includes alternative plans. Such exception to geographic proximity shall apply only to independent rural health clinics, provider-based rural health clinics if the provider is a critical access hospital as provided in title 42 United States Code section 1395i-4, and provider-based rural health clinics if the main location of the hospital sponsor is greater than fifty miles from the clinic. The collaborating physician shall maintain documentation related to such requirement and present it to the board when requested; and
(C) Provide coverage during absence, incapacity, infirmity, or emergency by the collaborating physician;
(6) A description of the assistant physician's controlled substance prescriptive authority in collaboration with the physician, including a list of the controlled substances the physician authorizes the assistant physician to prescribe and documentation that it is consistent with each professional's education, knowledge, skill, and competence;
(7) A list of all other written collaborative practice arrangements of the collaborating physician and the assistant physician;
(8) The duration of the written collaborative practice arrangements between the collaborating physician and the assistant physician;
(9) A description of the time and manner of the collaborating physician's review of the assistant physician's delivery of health care services. The description shall include provisions that the assistant physician shall submit a minimum of ten per cent of the charts documenting the assistant physician's delivery of health care services to the collaborating physician for review by the collaborating physician, or any other physician designated in the written collaborative practice arrangement, every fourteen days; and
(10) The collaborating physician, or any other physician designated in the written collaborative practice arrangement, shall review every fourteen days a minimum of twenty per cent of the charts in which the assistant physician prescribes controlled substances. The charts reviewed may be counted in the number of charts required to be reviewed under this part.
(m) The Hawaii medical board shall adopt rules regulating the use of written collaborative practice arrangements for assistant physicians. Such rules shall specify:
(1) Geographic areas to be covered;
(2) The methods of treatment that may be covered by written collaborative practice arrangements;
(3) In conjunction with the dean of the John H. Burns school of medicine and primary care residency program directors in the State, the development and implementation of educational methods and programs undertaken during the collaborative practice service which shall facilitate the advancement of the assistant physician's medical knowledge and capabilities, and which may lead to credit toward a future residency program for programs that deem such documented educational achievements acceptable; and
(4) The requirements for review of services provided under written collaborative practice arrangements, including delegating authority to prescribe controlled substances.
(n) Any rules relating to dispensing or distribution of medications or devices by prescription or prescription drug orders under this part shall be subject to the approval of the board.
(o) Any rules relating to dispensing or distribution of controlled substances by prescription or prescription drug orders under this part shall be subject to the approval of the department of public safety. The Hawaii medical board shall adopt rules applicable to assistant physicians that shall be consistent with guidelines for federally funded clinics. The rulemaking authority granted in this subsection shall not extend to written collaborative practice arrangements of hospital employees providing inpatient care within hospitals or population-based public health services.
(p) The Hawaii medical board shall not deny, revoke, suspend, or otherwise take disciplinary action against a collaborating physician for health care services delegated to an assistant physician provided the provisions of this section and the rules adopted thereunder are satisfied.
(q) Within thirty days of any change and on each license renewal, the Hawaii medical board shall require every physician to identify whether the physician is engaged in any written collaborative practice arrangement, including written collaborative practice arrangements delegating the authority to prescribe controlled substances, and also report to the board the name of each assistant physician with whom the physician has entered into such arrangement. The board may make such information available to the public. The board shall track the reported information and may routinely conduct random reviews of such arrangements to ensure that arrangements are carried in for compliance with this part.
(r) A collaborating physician shall not enter into a written collaborative practice arrangement with more than three full-time equivalent assistant physicians. Such limitation shall not apply to collaborative arrangements of hospital employees providing inpatient care service in hospitals or population-based public health services."
SECTION 3. This Act shall take effect on July 1, 2018 and shall be repealed on June 30, 2021.
Report Title:
Assistant Physicians; Health
Description:
Establishes a three-year pilot program to create a new category of professional licensure for assistant physicians, through which recent medical school graduates who have passed certain medical exams but have not been placed into a residency program may work under the supervision of a licensed physician to provide primary care in medically underserved areas. (HB1813 HD1)
The summary description
of legislation appearing on this page is for informational purposes only and is
not legislation or evidence of legislative intent.
