Bill Text: OH HB595 | 2009-2010 | 128th General Assembly | Introduced

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Bill Title: Regarding Medicaid reimbursement for physician assistants, immunity from civil liability for physicians and physician assistants providing certain emergency medical services, the determination and pronouncement of death by physician assistants, and the scope of practice and prescriptive authority of physician assistants.

Spectrum: Slight Partisan Bill (Democrat 5-3)

Status: (Introduced - Dead) 2010-10-13 - To Health [HB595 Detail]

Download: Ohio-2009-HB595-Introduced.html

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As Introduced

128th General Assembly Regular Session 2009-2010

H. B. No. 595

Representatives Letson, Wachtmann 

Cosponsors: Representatives Boyd, Gerberry, Sears, Slesnick, Stebelton, Walter 

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A BILL

To amend sections 2105.35, 2108.40, 4730.06, 4730.09,

1

4730.38, 4730.39, 4730.40, 4730.42, 4730.44,

2

4730.45, 4755.48, and 4755.481, to enact sections

3

2305.2310, 4730.04, 4730.53, and 5111.0212, and to

4

repeal section 4730.401 of the Revised Code

5

regarding Medicaid reimbursement for physician

6

assistants, immunity from civil liability for

7

physicians and physician assistants providing

8

certain emergency medical services, the

9

determination and pronouncement of death by

10

physician assistants, and the scope of practice

11

and prescriptive authority of physician

12

assistants.

13

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:

Section 1.  That sections 2105.35, 2108.40, 4730.06, 4730.09,	14
4730.38, 4730.39, 4730.40, 4730.42, 4730.44, 4730.45, 4755.48, and	15
4755.481 be amended and sections 2305.2310, 4730.04, 4730.53, and	16
5111.0212 of the Revised Code be enacted to read as follows:	17

Sec. 2105.35. (A)(1) A person is dead if the person has been	18
determined to be and pronounced dead pursuant to standards	19
established under section 2108.40 of the Revised Code.	20

(2) A physician or physician assistant who makes a	21
determination and pronouncement of death in accordance with	22
section 2108.40 of the Revised Code and any person who acts in	23
good faith in reliance on a determination and pronouncement of	24
death made by a physician in accordance with that section is	25
2108.40 of the Revised Code by a physician or physician assistant	26
are each entitled to the immunity conveyed by that section	27
2108.40 of the Revised Code.	28

(B) A certified or authenticated copy of a death certificate	29
purporting to be issued by an official or agency of the place	30
where the death of a person purportedly occurred is prima-facie	31
evidence of the fact, place, date, and time of the person's death	32
and the identity of the decedent.	33

(C) A certified or authenticated copy of any record or report	34
of a domestic or foreign governmental agency that a person is	35
missing, detained, dead, or alive is prima-facie evidence of the	36
status and of the dates, circumstances, and places disclosed by	37
the record or report.	38

(D) In the absence of prima-facie evidence of death under	39
division (B) or (C) of this section, the fact of death may be	40
established by clear and convincing evidence, including	41
circumstantial evidence.	42

(E) Except as provided in division (F) of this section, a	43
presumption of the death of a person arises:	44

(1) When the person has disappeared and been continuously	45
absent from the person's place of last domicile for a five-year	46
period without being heard from during the period;	47

(2) When the person has disappeared and been continuously	48
absent from the person's place of last domicile without being	49
heard from and was at the beginning of the person's absence	50
exposed to a specific peril of death, even though the absence has	51
continued for less than a five-year period.	52

(F) When a person who is on active duty in the armed services	53
of the United States has been officially determined to be absent	54
in a status of "missing" or "missing in action," a presumption of	55
death arises when the head of the federal department concerned has	56
made a finding of death pursuant to the "Federal Missing Persons	57
Act," 80 Stat. 625 (1966), 37 U.S.C.A. 551, as amended.	58

(G) In the absence of evidence disputing the time of death	59
stipulated on a document described in division (B) or (C) of this	60
section, a document described in either of those divisions that	61
stipulates a time of death one hundred twenty hours or more after	62
the time of death of another person, however the time of death of	63
the other person is determined, establishes by clear and	64
convincing evidence that the person survived the other person by	65
one hundred twenty hours.	66

(H) The provisions of divisions (A) to (G) of this section	67
are in addition to any other provisions of the Revised Code, the	68
Rules of Criminal Procedure, or the Rules of Evidence that pertain	69
to the determination of death and status of a person.	70

Sec. 2108.40. (A) An individual is dead if the individual has	71
sustained either irreversible cessation of circulatory and	72
respiratory functions or irreversible cessation of all functions	73
of the brain, including the brain stem, as determined in	74
accordance with accepted medical standards. If the respiratory and	75
circulatory functions of a person are being artificially	76
sustained, under accepted medical standards a determination that	77
death has occurred is made by a physician by observing and	78
conducting a test to determine that the irreversible cessation of	79
all functions of the brain has occurred.	80

(B) The determination and pronouncement of an individual's	81
death may be made by a physician or, subject to divisions (C) and	82
(D) of this section, a physician assistant.	83

(C) A physician assistant may determine and pronounce an	84
individual's death only if the individual's respiratory and	85
circulatory functions are not being artificially sustained and, at	86
the time the determination and pronouncement of death is made,	87
either or both of the following conditions are met:	88

(1) The individual was receiving care in one of the	89
following:	90

(a) A nursing home, residential care facility, or home for	91
the aging licensed under Chapter 3721. of the Revised Code;	92

(b) A county home or district home operated pursuant to	93
Chapter 5155. of the Revised Code;	94

(c) A residential facility licensed under section 5123.19 of	95
the Revised Code.	96

(2) The physician assistant is providing or supervising the	97
individual's care through a hospice care program licensed under	98
Chapter 3712. of the Revised Code or any other entity that	99
provides palliative care.	100

(D) If a physician assistant determines and pronounces an	101
individual's death, both of the following conditions apply:	102

(1) The physician assistant shall not complete any portion of	103
the individual's death certificate.	104

(2) The physician assistant shall notify the individual's	105
attending physician of the determination and pronouncement in	106
order for the physician to fulfill the physician's duties under	107
section 3705.16 of the Revised Code. The physician assistant shall	108
provide the notification within a reasonable period of time	109
following the determination and pronouncement of the individual's	110
death.	111

(E)(1) A physician who makes a determination and	112
pronouncement of death in accordance with this section and	113
accepted medical standards is not liable for damages, or subject	114
to, any of the following for the physician's acts, the acts of a	115
physician assistant who makes a determination and pronouncement of	116
death in accordance with this section and accepted medical	117
standards, or the acts of others based on a determination and	118
pronouncement of death in accordance with this section and	119
accepted medical standards:	120

(a) Damages in any civil action or subject to prosecution;

121

(b) Prosecution in any criminal proceeding for the	122
physician's acts or the acts of others based on that	123
determination;	124

(c) Professional disciplinary action pursuant to Chapter	125
4731. of the Revised Code.	126

(2) A physician assistant who makes a determination and	127
pronouncement of death in accordance with this section and	128
accepted medical standards is not liable for, or subject to, any	129
of the following for the physician assistant's acts or the acts of	130
others based on that determination and pronouncement:	131

(a) Damages in any civil action;

132

(b) Prosecution in any criminal proceeding;

133

(c) Professional disciplinary action pursuant to Chapter	134
4730. of the Revised Code.	135

(3) Any person who acts in good faith in reliance on a	136
determination and pronouncement of death made by a physician or	137
physician assistant in accordance with this section and accepted	138
medical standards is not liable for damages in any civil action or	139
subject to prosecution in any criminal proceeding for the person's	140
actions.	141

Sec. 2305.2310. (A) As used in this section:

142

(1) "Disaster" means any imminent threat or actual occurrence	143
of widespread or severe damage to or loss of property, personal	144
hardship or injury, or loss of life that results from any natural	145
phenomenon or act of a human.	146

(2) "Medical claim" has the same meaning as in section	147
2305.113 of the Revised Code.	148

(3) "Physician" means an individual authorized under Chapter	149
4731. of the Revised Code to practice medicine and surgery,	150
osteopathic medicine and surgery, or podiatric medicine and	151
surgery.	152

(4) "Reckless disregard" as it applies to a given physician	153
or physician assistant rendering emergency medical services means	154
conduct that a physician or physician assistant knew or should	155
have known, at the time those services were rendered, created an	156
unreasonable risk of injury, death, or loss to person or property	157
so as to affect the life or health of another and that risk was	158
substantially greater than that which is necessary to make the	159
conduct negligent.	160

(5) "Tort action" means a civil action for damages for	161
injury, death, or loss to person or property other than a civil	162
action for damages for a breach of contract or another agreement	163
between persons or governmental entities. "Tort action" includes	164
an action on a medical claim.	165

(B)(1) Subject to division (C)(3) of this section, a	166
physician or physician assistant who provides emergency medical	167
services, first-aid treatment, or other emergency professional	168
care, including the provision of any medication or other medical	169
product, in compliance with the "Emergency Medical Treatment and	170
Active Labor Act," 100 Stat. 164 (1986), 42 U.S.C. 1395dd, as	171
amended, is not liable in damages to any person in a tort action	172
for injury, death, or loss to person or property that allegedly	173
arises from an act or omission of the physician or physician	174
assistant in the physician's or physician assistant's provision of	175
those services or that treatment or care if that act or omission	176
does not constitute a reckless disregard for the consequences so	177
as to affect the life or health of the patient.	178

(2) Subject to division (C)(3) of this section, a physician	179
or physician assistant who provides emergency medical services,	180
first-aid treatment, or other emergency professional care,	181
including the provision of any medication or other medical	182
product, as a result of a disaster is not liable in damages to any	183
person in a tort action for injury, death, or loss to person or	184
property that allegedly arises from an act or omission of the	185
physician or physician assistant in the physician's or physician	186
assistant's provision of those services or that treatment or care	187
if that act or omission does not constitute willful or wanton	188
misconduct.	189

(C)(1) This section does not create a new cause of action or	190
substantive legal right against a physician or physician	191
assistant.	192

(2) This section does not affect any immunities from civil	193
liability or defenses established by another section of the	194
Revised Code or available at common law to which a physician or	195
physician assistant may be entitled in connection with the	196
provision of emergency medical services, first-aid treatment, or	197
other emergency professional care.	198

(3) This section does not grant an immunity from tort or	199
other civil liability to a physician or physician assistant for	200
actions that are outside the scope of authority of the physician	201
or physician assistant.	202

(4) This section does not affect any legal responsibility of	203
a physician or physician assistant to comply with any applicable	204
law of this state or rule of an agency of this state.	205

(D) This section does not apply to a tort action alleging	206
wrongful death against a physician or physician assistant who	207
provides emergency medical services, first-aid treatment, or other	208
emergency medical care, including the provision of any medication	209
or other medical product that allegedly arises from an act or	210
omission of the physician or physician assistant in the	211
physician's or physician assistant's provision of those services	212
or that treatment or care or as a result of a disaster.	213

Sec. 4730.04.  (A) As used in this section:

214

(1) "Disaster" means any imminent threat or actual occurrence	215
of widespread or severe damage to or loss of property, personal	216
hardship or injury, or loss of life that results from any natural	217
phenomenon or act of a human.	218

(2) "Emergency" means an occurrence or event that poses an	219
imminent threat to the health or life of a human.	220

(B) Nothing in this chapter prohibits any of the following	221
individuals from providing medical care, to the extent the	222
individual is able, in response to a need for such care	223
precipitated by a disaster or emergency:	224

(1) An individual who holds a certificate to practice as a	225
physician assistant issued under this chapter;	226

(2) An individual licensed or authorized to practice as a	227
physician assistant in another state;	228

(3) An individual credentialed or employed as a physician	229
assistant by an agency, office, or other instrumentality of the	230
United States government.	231

(C) Only for purposes of medical care provided by an	232
individual described in division (B)(1) of this section in	233
response to a need for such care precipitated by a disaster or	234
emergency, nothing in this chapter does either of the following:	235

(1) Requires the physician who supervises the physician	236
assistant pursuant to a physician supervisory plan approved by the	237
state medical board under section 4730.17 of the Revised Code to	238
meet the supervision requirements in this chapter;	239

(2) Prohibits the physician designated as the medical	240
director of the disaster or emergency from supervising the medical	241
care provided by the physician assistant.	242

(D)(1)(a) Except as provided in division (D)(1)(b) of this	243
section, an individual described in division (B) of this section	244
who voluntarily and without remuneration of any kind or the	245
expectation of remuneration provides medical care to the extent	246
the individual is able in response to a need for such care	247
precipitated by a disaster or an emergency shall not be liable in	248
damages to any person in a tort or other civil action for injury,	249
death, or loss to person or property that results from an act or	250
omission by the individual providing medical care.	251

(b) The immunity described in division (D)(1)(a) of this	252
section shall not apply to an act or omission that constitutes	253
willful or wanton misconduct or to medical care provided in a	254
hospital, physician office, or other facility where medical	255
services are provided on a routine or regular basis.	256

(2) Only for purposes of medical care provided by an	257
individual described in division (B) of this section in response	258
to a need for such care precipitated by a disaster or emergency,	259
the physician who supervises such individual pursuant to a	260
physician supervisory plan approved by the state medical board	261
under section 4730.17 of the Revised Code or pursuant to a similar	262
plan required by a law of another state or the United States shall	263
not be liable in damages to any person in a tort or other civil	264
action for injury, death, or loss to person or property that	265
results from an act or omission of the individual who provided the	266
medical care.	267

Sec. 4730.06.  (A) The physician assistant policy committee	268
of the state medical board shall review, and shall submit to the	269
board recommendations concerning, all of the following:	270

(1) Requirements for issuance of certificates to practice as	271
a physician assistant, including the educational requirements that	272
must be met to receive a certificate to practice;	273

(2) Existing and proposed rules pertaining to the practice of	274
physician assistants, the supervisory relationship between	275
physician assistants and supervising physicians, and the	276
administration and enforcement of this chapter;	277

(3) Physician-delegatedIn accordance with section 4730.38 of	278
the Revised Code, physician-delegated prescriptive authority for	279
physician assistants, in accordance withand proposed changes to	280
the physician assistant formulary the board adopts pursuant to	281
division (A)(1) of section 4730.384730.39 of the Revised Code;	282

(4) Application procedures and forms for certificates to	283
practice as a physician assistant, physician supervisory plans,	284
and supervision agreements;	285

(5) Fees required by this chapter for issuance and renewal of	286
certificates to practice as a physician assistant;	287

(6) Criteria to be included in applications submitted to the	288
board for approval of physician supervisory plans, including	289
criteria to be included in applications for approval to delegate	290
to physician assistants the performance of special services;	291

(7) Criteria to be included in supervision agreements	292
submitted to the board for approval and renewal of the board's	293
approval;	294

(8) Any issue the board asks the committee to consider.

295

(B) In addition to the matters that are required to be	296
reviewed under division (A) of this section, the committee may	297
review, and may submit to the board recommendations concerning,	298
either or both of the following:	299

(1) Quality assurance activities to be performed by a	300
supervising physician and physician assistant under a quality	301
assurance system established pursuant to division (F) of section	302
4730.21 of the Revised Code;	303

(2) The development and approval of one or more model	304
physician supervisory plans and one or more models for a special	305
services portion of the one or more model physician supervisory	306
plans. The committee may submit recommendations for model plans	307
that reflect various medical specialties.	308

(C) The board shall take into consideration all	309
recommendations submitted by the committee. Not later than ninety	310
days after receiving a recommendation from the committee, the	311
board shall approve or disapprove the recommendation and notify	312
the committee of its decision. If a recommendation is disapproved,	313
the board shall inform the committee of its reasons for making	314
that decision. The committee may resubmit the recommendation after	315
addressing the concerns expressed by the board and modifying the	316
disapproved recommendation accordingly. Not later than ninety days	317
after receiving a resubmitted recommendation, the board shall	318
approve or disapprove the recommendation. There is no limit on the	319
number of times the committee may resubmit a recommendation for	320
consideration by the board.	321

(D)(1) Except as provided in division (D)(2) of this section,	322
the board may not take action regarding a matter that is subject	323
to the committee's review under division (A) or (B) of this	324
section unless the committee has made a recommendation to the	325
board concerning the matter.	326

(2) If the board submits to the committee a request for a	327
recommendation regarding a matter that is subject to the	328
committee's review under division (A) or (B) of this section, and	329
the committee does not provide a recommendation before the	330
sixty-first day after the request is submitted, the board may take	331
action regarding the matter without a recommendation.	332

Sec. 4730.09. (A) Under a physician supervisory plan approved	333
under section 4730.17 of the Revised Code, a physician assistant	334
may provide any or all of the following services without approval	335
by the state medical board as special services:	336

(1) Obtaining comprehensive patient histories;

337

(2) Performing physical examinations, including audiometry	338
screening, routine visual screening, and pelvic, rectal, and	339
genital-urinary examinations, when indicated;	340

(3) Ordering, performing, or ordering and performing routine	341
diagnostic procedures, as indicated;	342

(4) Identifying normal and abnormal findings on histories,	343
physical examinations, and commonly performed diagnostic studies;	344

(5) Assessing patients and developing and implementing	345
treatment plans for patients;	346

(6) Monitoring the effectiveness of therapeutic	347
interventions;	348

(7) Exercising physician-delegated prescriptive authority	349
pursuant to a certificate to prescribe issued under this chapter;	350

(8) Carrying out or relaying the supervising physician's	351
orders for the administration of medication, to the extent	352
permitted by law;	353

(9) Providing patient education;

354

(10) Instituting and changing orders on patient charts;

355

(11) Performing developmental screening examinations on	356
children with regard to neurological, motor, and mental functions;	357

(12) Performing wound care management, suturing minor	358
lacerations and removing the sutures, and incision and drainage of	359
uncomplicated superficial abscesses;	360

(13) Removing superficial foreign bodies;

361

(14) Administering intravenous fluids;

362

(15) Inserting a foley or cudae catheter into the urinary	363
bladder and removing the catheter;	364

(16) Removing intrauterine devices;

365

(17) Performing biopsies of superficial lesions;

366

(18)(17) Making appropriate referrals as directed by the	367
supervising physician;	368

(19) Removing norplant capsules

369

(18) Removing birth control devices;

370

(20)(19) Performing penile duplex ultrasound;

371

(21)(20) Changing of a tracheostomy;

372

(22)(21) Performing bone marrow aspirations from the	373
posterior iliac crest;	374

(23)(22) Performing bone marrow biopsies from the posterior	375
iliac crest;	376

(24)(23) Performing cystograms;

377

(25)(24) Performing nephrostograms after physician placement	378
of nephrostomy tubes;	379

(26)(25) Fitting or inserting family planning devices,	380
including intrauterine devices, diaphragms, and cervical caps;	381

(27)(26) Removing cervical polyps;

382

(28)(27) Performing nerve conduction testing;

383

(29)(28) Performing endometrial biopsies;

384

(30)(29) Inserting filiform and follower catheters;

385

(31)(30) Performing arthrocentesis of the knee;

386

(32)(31) Performing knee joint injections;

387

(33)(32) Performing endotracheal intubation with successful	388
completion of an advanced cardiac life support course;	389

(34)(33) Performing lumbar punctures;

390

(35)(34) In accordance with rules adopted by the board, using	391
light-based medical devices for the purpose of hair removal;	392

(36)(35) Administering, monitoring, or maintaining local	393
anesthesia, as defined in section 4730.091 of the Revised Code;	394

(37)(36) Applying or removing a cast or splint;

395

(38)(37) Inserting or removing chest tubes;

396

(38) Prescribing or referring a patient to a physical	397
therapist for the purpose of receiving physical therapy, as	398
defined in section 4755.40 of the Revised Code;	399

(39) Performing other services that are within the	400
supervising physician's normal course of practice and expertise,	401
if the services are included in any model physician supervisory	402
plan approved under section 4730.06 of the Revised Code or the	403
services are designated by the board by rule or other means as	404
services that are not subject to approval as special services.	405

(B) Under the policies of a health care facility, the	406
services a physician assistant may provide are limited to the	407
services the facility has authorized the physician assistant to	408
provide for the facility. The services a health care facility may	409
authorize a physician assistant to provide for the facility	410
include the following:	411

(1) Any or all of the services specified in division (A) of	412
this section;	413

(2) Assisting in surgery in the health care facility;

414

(3) Any other services permitted by the policies of the	415
health care facility, except that the facility may not authorize a	416
physician assistant to perform a service that is prohibited by	417
this chapter.	418

Sec. 4730.38.  (A) Not later than six months after the	419
effective dateExcept as provided in division (B) of this section,	420
the physician assistant policy committee of the state medical	421
board shall, at such times the committee determines to be	422
necessary, submit to the board its initial recommendations	423
regarding physician-delegated prescriptive authority for physician	424
assistants. The committee's recommendations shall address allboth	425
of the following:	426

(1) Policy and procedures regarding physician-delegated	427
prescriptive authority, including the issuance of certificates to	428
prescribe under this chapter;	429

(2) Subject to the limitations specified in section 4730.40	430
of the Revised Code, a formulary listing the drugs and therapeutic	431
devices by class and specific nomenclature that a supervising	432
physician may include in the physician-delegated prescriptive	433
authority granted to a physician assistant who holds a certificate	434
to prescribe issued under this chapter;	435

(3) Any issue the committee considers necessary to assist the	436
board in fulfilling its duty to adopt rules governing	437
physician-delegated prescriptive authority, including the issuance	438
of certificates to prescribe.	439

(B) After the board's adoption of initial rules under section	440
4730.39 of the Revised Code, the committee shall conduct an annual	441
review of its recommendations regarding physician-delegated	442
prescriptive authority. Based on its review, the committee shall	443
submit recommendations to the board as the committee considers	444
necessaryNot less than every six months beginning on the first	445
day of June following the effective date of this amendment, the	446
committee shall review the physician assistant formulary the board	447
adopts pursuant to division (A)(1) of section 4730.39 of the	448
Revised Code and, to the extent it determines to be necessary,	449
submit recommendations proposing changes to the formulary.	450

(C) Recommendations submitted under this section are subject	451
to the procedures and time frames specified in division (C) of	452
section 4730.06 of the Revised Code.	453

Sec. 4730.39.  (A) Not later than six months after receiving	454
the initial recommendations of the physician assistant policy	455
committee submitted pursuant to division (A) of section 4730.38 of	456
the Revised Code, theThe state medical board shall adoptdo both	457
of the following:	458

(1) Adopt a formulary listing the drugs and therapeutic	459
devices by class and specific generic nomenclature that a	460
physician may include in the physician-delegated prescriptive	461
authority granted to a physician assistant who holds a certificate	462
to prescribe under this chapter;	463

(2) Adopt rules governing physician-delegated prescriptive	464
authority for physician assistants, including the issuance of	465
certificates to prescribe under this chapter. The	466

(B) The board's rules governing physician-delegated	467
prescriptive authority adopted pursuant to division (A)(2) of this	468
section shall be adopted in accordance with Chapter 119. of the	469
Revised Code and shall establish all of the following:	470

(1) Subject to the limitations specified in section 4730.40	471
of the Revised Code, a formulary listing the drugs and therapeutic	472
devices by class and specific generic nomenclature that a	473
physician may include in the physician-delegated prescriptive	474
authority granted to a physician assistant who holds a certificate	475
to prescribe under this chapter;	476

(2) Requirements regarding the pharmacology courses that a	477
physician assistant is required to complete to receive a	478
certificate to prescribe;	479

(3)(2) Standards and procedures for the issuance and renewal	480
of certificates to prescribe to physician assistants;	481

(4)(3) Standards and procedures for the appropriate conduct	482
of the provisional period that a physician assistant is required	483
to complete pursuant to section 4730.45 of the Revised Code and	484
for determining whether a physician assistant has successfully	485
completed the provisional period;	486

(5)(4) A specific prohibition against prescribing any drug or	487
device to perform or induce an abortion;	488

(6)(5) Standards and procedures to be followed by a physician	489
assistant in personally furnishing samples of drugs or complete or	490
partial supplies of drugs to patients under section 4730.43 of the	491
Revised Code;	492

(7)(6) Any other requirements the board considers necessary	493
to implement the provisions of this chapter regarding	494
physician-delegated prescriptive authority and the issuance of	495
certificates to prescribe.	496

(B)(C)(1) After adopting the initial rulesconsidering	497
recommendations submitted by the physician assistant policy	498
committee pursuant to sections 4730.06 and 4730.38 of the Revised	499
Code, the board shall conduct an annual review either or both of	500
the rules. Basedfollowing, as appropriate according to the	501
submitted recommendations:	502

(a) The formulary the board adopts under division (A)(1) of	503
this section;	504

(b) The rules the board adopts under division (A)(2) of this	505
section regarding physician-delegated prescriptive authority.	506

(2) Based on its review, the board shall make any necessary	507
modifications to the formulary or rules.	508

(C) All rules adopted under this section shall be adopted in	509
accordance with Chapter 119. of the Revised Code. When adopting	510
the initial rules, the board shall consider the recommendations of	511
the physician assistant policy committee submitted pursuant to	512
division (A) of section 4730.38 of the Revised Code. When making	513
any modifications to the rules subsequent to its annual review of	514
the rules, the board shall consider the committee's	515
recommendations submitted pursuant to division (B) of section	516
4730.38 of the Revised Code.	517

Sec. 4730.40.  (A) Subject to divisionsdivision (B) and (C)	518
of this section, the physician assistant formulary established	519
adopted by the state medical board in rules adopted under section	520
4730.39 of the Revised Code listing the drugs and therapeutic	521
devices by class and specific nomenclature that a supervising	522
physician may include in the physician-delegated prescriptive	523
authority granted to a physician assistant who holds a certificate	524
to prescribe issued under this chapter may include any or all of	525
the following drugs:	526

(1) Schedule II, III, IV, and V controlled substances;

527

(2) Drugs that under state or federal law may be dispensed	528
only pursuant to a prescription by a licensed health professional	529
authorized to prescribe drugs, as defined in section 4729.01 of	530
the Revised Code;	531

(3) Any drug that is not a dangerous drug, as defined in	532
section 4729.01 of the Revised Code.	533

(B) The formulary established in the board's rulesadopted by	534
the board shall not include, and shall specify that it does not	535
include, the following:	536

(1) Any schedule II controlled substance;

537

(2) Anyany drug or device used to perform or induce an	538
abortion.	539

(C) When adopting rules establishing the initial formulary,	540
the board shall include provisions ensuring that a physician	541
assistant who holds a certificate to prescribe issued under this	542
chapter may be granted physician-delegated prescriptive authority	543
for all drugs and therapeutic devices that may be prescribed on	544
the effective date of the rules by a holder of a certificate to	545
prescribe issued by the board of nursing under Chapter 4723. of	546
the Revised Code, with the exception of schedule II controlled	547
substances. To the extent permitted by division (A) of this	548
section, the initial formulary may include additional drugs or	549
therapeutic devices.	550

Sec. 4730.42.  (A) In granting physician-delegated	551
prescriptive authority to a particular physician assistant who	552
holds a certificate to prescribe issued under this chapter, the	553
supervising physician is subject to all of the following:	554

(1) The supervising physician shall not grant	555
physician-delegated prescriptive authority for any drug or	556
therapeutic device that is not listed on the physician assistant	557
formulary established in rules adopted under section 4730.39 of	558
the Revised Code as a drug or therapeutic device that may be	559
included in the physician-delegated prescriptive authority granted	560
to a physician assistant.	561

(2) The supervising physician shall not grant	562
physician-delegated prescriptive authority for any drug or device	563
that may be used to perform or induce an abortion.	564

(3) The supervising physician shall not grant	565
physician-delegated prescriptive authority in a manner that	566
exceeds the supervising physician's prescriptive authority.	567

(4) The supervising physician shall supervise the physician	568
assistant in accordance with all of the following:	569

(a) The supervision requirements specified in section 4730.21	570
of the Revised Code and, in the case of supervision provided	571
during a provisional period of physician-delegated prescriptive	572
authority, the supervision requirements specified in section	573
4730.45 of the Revised Code;	574

(b) The physician supervisory plan approved for the	575
supervising physician or the policies of the health care facility	576
in which the physician and physician assistant are practicing;	577

(c) The supervision agreement approved under section 4730.19	578
of the Revised Code that applies to the supervising physician and	579
the physician assistant.	580

(B)(1) The supervising physician of a physician assistant may	581
place conditions on the physician-delegated prescriptive authority	582
granted to the physician assistant. If conditions are placed on	583
that authority, the supervising physician shall maintain a written	584
record of the conditions and make the record available to the	585
state medical board on request.	586

(2) The conditions that a supervising physician may place on	587
the physician-delegated prescriptive authority granted to a	588
physician assistant include the following:	589

(a) Identification by class and specific generic nomenclature	590
of drugs and therapeutic devices that the physician chooses not to	591
permit the physician assistant to prescribe;	592

(b) Limitations on the dosage units or refills that the	593
physician assistant is authorized to prescribe;	594

(c) Specification of circumstances under which the physician	595
assistant is required to refer patients to the supervising	596
physician or another physician when exercising physician-delegated	597
prescriptive authority;	598

(d) Responsibilities to be fulfilled by the physician in	599
supervising the physician assistant that are not otherwise	600
specified in the physician supervisory plan or otherwise required	601
by this chapter.	602

Sec. 4730.44. (A) A physician assistant seeking a certificate	603
to prescribe shall submit to the state medical board a written	604
application on a form prescribed and supplied by the board. The	605
application shall include all of the following information:	606

(1) The applicant's name, residential address, business	607
address, if any, and social security number;	608

(2) Evidence of holding a valid certificate to practice as a	609
physician assistant issued under this chapter;	610

(3) Either of the following:

611

(a) Satisfactory proof that the applicant meets the	612
requirements specified in section 4730.46 of the Revised Code to	613
participate in a provisional period of physician-delegated	614
prescriptive authority or satisfactory proof of successful	615
completion of the provisional period, evidenced by a letter or	616
copy of a letter attesting to the successful completion written by	617
a supervising physician of the physician assistant at the time of	618
completion;	619

(b) Satisfactory proof that the applicant has practiced as a	620
physician assistant in another state or was credentialed or	621
employed as a physician assistant by the United States government,	622
holds a master's or higher degree that was obtained from a program	623
accredited by the accreditation review commission on education for	624
the physician assistant or a predecessor or successor organization	625
recognized by the board, and held valid authority issued by the	626
other state or the United States government to prescribe	627
therapeutic devices and drugs, including at least some controlled	628
substances, evidenced by an affidavit issued by an appropriate	629
agency or office of the other state or the United States	630
government attesting to the prescriptive authority described in	631
division (A)(3)(b) of this section.	632

(4) Any other information the board requires.

633

(B) At the time of making application for a certificate to	634
prescribe, the applicant shall pay the board a fee of one hundred	635
dollars, no part of which shall be returned. The fees shall be	636
deposited in accordance with section 4731.24 of the Revised Code.	637

(C)(1) The board shall review all applications received. If	638
an application is complete and the board determines that the	639
applicant meets the requirements for a certificate to prescribe,	640
the board shall, subject to division (C)(2) of this section, issue	641
the certificate to the applicant. The	642

(2) The initial certificate to prescribe issued to an	643
applicant who meets the requirements of division (A)(3)(a) of this	644
section shall be issued as a provisional certificate to prescribe.	645

Sec. 4730.45.  (A) A provisional certificate to prescribe	646
issued under division (C)(2) of section 4730.44 of the Revised	647
Code authorizes the physician assistant holding the certificate to	648
participate in a provisional period of physician-delegated	649
prescriptive authority. The physician assistant shall successfully	650
complete the provisional period as a condition of receiving a new	651
certificate to prescribe.	652

(B) The provisional period shall be conducted by one or more	653
supervising physicians in accordance with rules adopted under	654
section 4730.39 of the Revised Code. When supervising a physician	655
assistant who is completing the first five hundred hours of a	656
provisional period, the supervising physician shall provide	657
on-site supervision of the physician assistant's exercise of	658
physician-delegated prescriptive authority.	659

The provisional period shall last not longer than one year,	660
unless it is extended for not longer than one additional year at	661
the direction of a supervising physician. The physician assistant	662
shall not be required to participate in the provisional period for	663
more than one-thousand-eight-hundredone thousand eight hundred	664
hours, except when a supervising physician has extended the	665
physician assistant's provisional period.	666

(C) If a physician assistant does not successfully complete	667
the provisional period, each supervising physician shall cease	668
granting physician-delegated prescriptive authority to the	669
physician assistant. The supervising physician with primary	670
responsibility for conducting the provisional period shall	671
promptly notify the state medical board that the physician	672
assistant did not successfully complete the provisional period and	673
the board shall revoke the certificate.	674

(D) A physician assistant who successfully completes a	675
provisional period shall not be required to complete another	676
provisional period as a condition of being eligible to be granted	677
physician-delegated prescriptive authority by a supervising	678
physician who was not involved in the conduct of the provisional	679
period.	680

Sec. 4730.53. A physician assistant who provides services	681
under the medicaid program established under Chapter 5111. of the	682
Revised Code shall enter into a medicaid provider agreement with	683
the department of job and family services. When submitting a claim	684
for reimbursement from the medicaid program, the physician	685
assistant shall use only the medicaid provider number the	686
department assigns to the physician assistant.	687

Sec. 4755.48.  (A) No person shall employ fraud or deception	688
in applying for or securing a license to practice physical therapy	689
or to be a physical therapist assistant.	690

(B) No person shall practice or in any way imply or claim to	691
the public by words, actions, or the use of letters as described	692
in division (C) of this section to be able to practice physical	693
therapy or to provide physical therapy services, including	694
practice as a physical therapist assistant, unless the person	695
holds a valid license under sections 4755.40 to 4755.56 of the	696
Revised Code or except for submission of claims as provided in	697
section 4755.56 of the Revised Code.	698

(C) No person shall use the words or letters, physical	699
therapist, physical therapy, physical therapy services,	700
physiotherapist, physiotherapy, physiotherapy services, licensed	701
physical therapist, P.T., Ph.T., P.T.T., R.P.T., L.P.T., M.P.T.,	702
D.P.T., M.S.P.T., P.T.A., physical therapy assistant, physical	703
therapist assistant, physical therapy technician, licensed	704
physical therapist assistant, L.P.T.A., R.P.T.A., or any other	705
letters, words, abbreviations, or insignia, indicating or implying	706
that the person is a physical therapist or physical therapist	707
assistant without a valid license under sections 4755.40 to	708
4755.56 of the Revised Code.	709

(D) No person who practices physical therapy or assists in	710
the provision of physical therapy treatments under the supervision	711
of a physical therapist shall fail to display the person's current	712
license granted under sections 4755.40 to 4755.56 of the Revised	713
Code in a conspicuous location in the place where the person	714
spends the major part of the person's time so engaged.	715

(E) Nothing in sections 4755.40 to 4755.56 of the Revised	716
Code shall affect or interfere with the performance of the duties	717
of any physical therapist or physical therapist assistant in	718
active service in the army, navy, coast guard, marine corps, air	719
force, public health service, or marine hospital service of the	720
United States, while so serving.	721

(F) Nothing in sections 4755.40 to 4755.56 of the Revised	722
Code shall prevent or restrict the activities or services of a	723
person pursingpursuing a course of study leading to a degree in	724
physical therapy in an accredited or approved educational program	725
if the activities or services constitute a part of a supervised	726
course of study and the person is designated by a title that	727
clearly indicates the person's status as a student.	728

(G) No(1) Except as provided in division (G)(2) of this	729
section and subject to division (H) of this section, no person	730
shall practice physical therapy other than on the prescription of,	731
or the referral of a patient by, a person who is licensed in this	732
or another state to practicedo at least one of the following:	733

(a) Practice medicine and surgery, chiropractic, dentistry,	734
osteopathic medicine and surgery, podiatric medicine and surgery,	735
or to practice;	736

(b) Practice as a physician assistant;

737

(c) Practice nursing as a certified registered nurse	738
anesthetist, clinical nurse specialist, certified nurse-midwife,	739
or certified nurse practitioner, within the scope of such	740
practices, and whose license is in good standing, unless either of	741
the following conditions is met:.	742

(1)(2) The prohibition in division (G)(1) of this section on	743
practicing physical therapy other than on the prescription of, or	744
the referral of a patient by, any of the persons described in that	745
division does not apply if either of the following applies to the	746
person:	747

(a) The person holds a master's or doctorate degree from a	748
professional physical therapy program that is accredited by a	749
national physical therapy accreditation agency recognized by the	750
United States department of education.	751

(2)(b) On or before December 31, 2004, the person has	752
completed at least two years of practical experience as a licensed	753
physical therapist.	754

(H) To be authorized to prescribe physical therapy or refer	755
a patient to a physical therapist for physical therapy, a person	756
described in division (G)(1) of this section must be in good	757
standing with the relevant licensing board in this state or the	758
state in which the person is licensed and must act only within the	759
person's scope of practice.	760

(I) In the prosecution of any person for violation of	761
division (B) or (C) of this section, it is not necessary to allege	762
or prove want of a valid license to practice physical therapy or	763
to practice as a physical therapist assistant, but such matters	764
shall be a matter of defense to be established by the accused.	765

Sec. 4755.481. (A) If a physical therapist evaluates and	766
treats a patient without the prescription of, or the referral of	767
the patient by, a person who is licensed to practice medicine and	768
surgery, chiropractic, dentistry, osteopathic medicine and	769
surgery, podiatric medicine and surgery, or nursing as a certified	770
registered nurse anesthetist, clinical nurse specialist, certified	771
nurse-midwife, or certified nurse practitionerdescribed in	772
division (G)(1) of section 4755.48 of the Revised Code, all of the	773
following apply:	774

(1) The physical therapist shall, upon consent of the	775
patient, inform the patient's physician, chiropractor, dentist,	776
podiatrist, certified registered nurse anesthetist, clinical nurse	777
specialist, certified nurse-midwife, or certified nurse	778
practitionerrelevant person described in division (G)(1) of	779
section 4755.48 of the Revised Code of the evaluation not later	780
than five business days after the evaluation is made.	781

(2) If the physical therapist determines, based on reasonable	782
evidence, that no substantial progress has been made with respect	783
to that patient during the thirty-day period immediately following	784
the date of the patient's initial visit with the physical	785
therapist, the physical therapist shall consult with or refer the	786
patient to a licensed physician, chiropractor, dentist,	787
podiatrist, certified registered nurse anesthetist, clinical nurse	788
specialist, certified nurse-midwife, or certified nurse	789
practitionerperson described in division (G)(1) of section	790
4755.48 of the Revised Code, unless either of the following	791
applies:	792

(a) The evaluation, treatment, or services are being provided	793
for fitness, wellness, or prevention purposes.	794

(b) The patient previously was diagnosed with chronic,	795
neuromuscular, or developmental conditions and the evaluation,	796
treatment, or services are being provided for problems or symptoms	797
associated with one or more of those previously diagnosed	798
conditions.	799

(3) If the physical therapist determines that orthotic	800
devices are necessary to treat the patient, the physical therapist	801
shall be limited to the application of the following orthotic	802
devices:	803

(a) Upper extremity adaptive equipment used to facilitate the	804
activities of daily living;	805

(b) Finger splints;

806

(c) Wrist splints;

807

(d) Prefabricated elastic or fabric abdominal supports with	808
or without metal or plastic reinforcing stays and other	809
prefabricated soft goods requiring minimal fitting;	810

(e) Nontherapeutic accommodative inlays;

811

(f) Shoes that are not manufactured or modified for a	812
particular individual;	813

(g) Prefabricated foot care products;

814

(h) Custom foot orthotics;

815

(i) Durable medical equipment.

816

(4) If, at any time, the physical therapist has reason to	817
believe that the patient has symptoms or conditions that require	818
treatment or services beyond the scope of practice of a physical	819
therapist, the physical therapist shall refer the patient to a	820
licensed health care practitioner acting within the practitioner's	821
scope of practice.	822

(B) Nothing in sections 4755.40 to 4755.56 of the Revised	823
Code shall be construed to require reimbursement under any health	824
insuring corporation policy, contract, or agreement, any sickness	825
and accident insurance policy, the medical assistance program as	826
defined in section 5111.01 of the Revised Code, or the health	827
partnership program or qualified health plans established pursuant	828
to sections 4121.44 to 4121.442 of the Revised Code, for any	829
physical therapy service rendered without the prescription of, or	830
the referral of the patient by, a licensed physician,	831
chiropractor, dentist, podiatrist, certified registered nurse	832
anesthetist, clinical nurse specialist, certified nurse-midwife,	833
or certified nurse practitionerperson described in division	834
(G)(1) of section 4755.48 of the Revised Code.	835

(C) For purposes of this section, "business day" means any	836
calendar day that is not a Saturday, Sunday, or legal holiday.	837
"Legal holiday" has the same meaning as in section 1.14 of the	838
Revised Code.	839

Sec. 5111.0212. For any service a physician assistant	840
provides to a medicaid recipient in accordance with Chapter 4730.	841
of the Revised Code, the medicaid program shall reimburse the	842
physician assistant an amount that is one hundred per cent of the	843
amount, as contained in the medicaid fee schedule determined	844
pursuant to rules adopted under section 5111.02 of the Revised	845
Code, established as the medicaid maximum for the service.	846

Section 2.  That existing sections 2105.35, 2108.40, 4730.06,	847
4730.09, 4730.38, 4730.39, 4730.40, 4730.42, 4730.44, 4730.45,	848
4755.48, and 4755.481 and section 4730.401 of the Revised Code	849
are hereby repealed.	850