75th OREGON LEGISLATIVE ASSEMBLY--2010 Special Session

                            Enrolled

                         House Bill 3642

Sponsored by Representatives NATHANSON, GREENLICK;
  Representatives BARKER, BARNHART, BOONE, BUCKLEY, DEMBROW,
  DOHERTY, FREDERICK, HARKER, HOLVEY, HOYLE, KOMP, KOTEK,
  MATTHEWS, NOLAN, ROBLAN, STIEGLER, TOMEI, VANORMAN, WITT,
  Senator MONNES ANDERSON (Presession filed.)

                     CHAPTER ................

                             AN ACT

Relating to physician assistants; amending ORS 409.565, 677.495,
  677.500, 677.510, 677.515, 677.518, 677.535, 677.545 and
  743A.044; and declaring an emergency.

Be It Enacted by the People of the State of Oregon:

  SECTION 1. ORS 677.495 is amended to read:
  677.495. As used in ORS 677.495 to 677.545, unless the context
requires otherwise:
  (1) 'Agent' means a physician designated by the supervising
physician of a physician assistant who supervises the medical
services of the physician assistant for a predetermined period of
time.
  (2) 'Committee' means the Physician Assistant Committee created
in ORS 677.540.
  (3) 'Physician assistant' means a person who is licensed in
accordance with ORS 677.505 to 677.525.
   { +  (4) 'Supervising physician' means a physician licensed to
practice medicine under this chapter who supervises a physician
assistant.
  (5) 'Supervising physician organization' means a group of
supervising physicians that collectively supervises a physician
assistant. + }
    { - (4) - }   { + (6) + } 'Supervision' means the routine
direction and regular review by the supervising physician  { + or
supervising physician organization + }, as determined to be
appropriate by the Oregon Medical Board, of the medical services
provided by the physician assistant.   { - The practice
description shall provide for the maintenance of direct, verbal
communication either in person or by means described in ORS
677.515 (4)(a) but the description shall not require the physical
presence at all times of the supervising physician. - }
  SECTION 2. ORS 677.500 is amended to read:
  677.500. It is the intent of the Legislative Assembly in
requiring the licensure of physician assistants that there be
reasonable utilization of the physician assistant by the
supervising physician { +  or supervising physician
organization + }.
  SECTION 3. ORS 677.510 is amended to read:

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  677.510. (1) A person licensed to practice medicine under this
chapter shall not use the services of a physician assistant
without the prior approval of the Oregon Medical Board.
   { +  (2) A supervising physician or a supervising physician
organization may apply to the board to use the services of a
physician assistant. + } The application shall { + :
  (a) + } State the name of the physician assistant  { - , - }
 { + ;
  (b) If the applicant is a supervising physician organization:
  (A) State the names of all supervising physicians; and
  (B) State the name of the primary supervising physician
required by subsection (5) of this section;
  (c) + } Describe the manner and extent to which the physician
assistant's services would be used and supervised  { - , - }
 { + ;
  (d) Include a practice description that provides for the
maintenance of direct, verbal communication between the physician
assistant and one or more supervising physicians either in person
or by means described in ORS 677.515 (4);
  (e)  + }State the education, training and experience of the
physician assistant { + ; + } and
   { +  (f) + } Provide such other information in such a form as
the board may require.
    { - (2) - }   { + (3) + } The board may approve or reject an
application, or it may modify the proposed use of the services of
the physician assistant and approve the application as modified.
 { + The board may not require that a supervising physician be
physically present at all times.
  (4) A supervising physician organization shall provide the
board with a list of the supervising physicians in the
supervising physician organization. The supervising physician
organization shall continually update the list and notify the
board of any changes.
  (5) A supervising physician organization shall designate a
primary supervising physician and notify the board in the manner
prescribed by the board.
  (6) + } When it appears to the board that the services of a
physician assistant are being used in a manner inconsistent with
the approval granted, the board may withdraw its approval. If a
hearing is requested by the  { + supervising + } physician { + ,
the supervising physician organization + } or the physician
assistant upon the rejection of an application  { - , - }  or
upon the withdrawal of an approval, a hearing shall be conducted
in accordance with ORS 677.200.
    { - (3)(a) - }   { + (7) + }   { - The - }   { + A + }
supervising physician may have a different specialty from the
physician assistant.
   { +  (8)(a) A supervising physician organization may supervise
any number of physician assistants. The board may not adopt rules
limiting the number of physician assistants that a supervising
physician organization may supervise.
  (b) A physician assistant who is supervised by a supervising
physician organization may be supervised by any of the
supervising physicians in the supervising physician organization.
  (9) If a physician assistant is not supervised by a supervising
physician organization, the + }   { - A - }  physician assistant
may be supervised by no more than four  { + supervising + }
physicians. A  { +  supervising + } physician  { + who is not
acting as part of a supervising physician organization + } may
supervise four physician assistants. A supervising physician

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 { + who is not acting as part of a supervising physician
organization + } may designate a physician to serve as the agent
of the supervising physician for a predetermined period of time.
    { - (b) - }   { + (10) + } The board may review and approve
applications from physicians serving federally designated
underserved populations, or physicians in federally designated
health professional shortage areas, federally designated
medically underserved areas or areas designated as medically
disadvantaged and in need of primary health care providers by the
Director of the Oregon Health Authority or the Office of Rural
Health to supervise more than four physician assistants, and
applications from physician assistants to be supervised by more
than four physicians. A physician assistant may render services
in an emergency room and other hospital settings, a nursing home,
a corrections institution and any site included in the practice
description.
    { - (4) - }   { + (11) + } A licensed physician assistant may
make application to the board for emergency drug dispensing
authority.  The board shall consider the criteria adopted by the
Physician Assistant Committee under ORS 677.545 (4) in reviewing
the application. Such emergency dispensing shall be of drugs
prepared or prepackaged by a licensed pharmacist, manufacturing
drug outlet or wholesale drug outlet authorized to do so under
ORS chapter 689.
    { - (5) - }   { + (12) + } A physician assistant for whom an
application under   { - subsection (1) of - }  this section has
been approved by the board on or after January 2, 2006, shall
submit to the board, within 24 months after the approval,
documentation of completion of:
  (a) A pain management education program approved by the board
and developed in conjunction with the Pain Management Commission
established under ORS 409.500; or
  (b) An equivalent pain management education program, as
determined by the board.
  SECTION 4. ORS 677.515 is amended to read:
  677.515. (1) This chapter does not prohibit a person from
rendering medical services:
  (a) If the person has satisfactorily completed an educational
program for physician assistants  { - , - }  approved by the
Oregon Medical Board  { - , for physician assistants - } ;
  (b) If the services are rendered under the supervision and
control of a   { - person licensed under this chapter to practice
medicine - }   { + supervising physician or supervising physician
organization + } and the use of the physician assistant's
services has been approved by the board as provided by ORS
677.510; and
  (c) If the person is licensed as a physician assistant as
provided by ORS 677.495 and 677.505 to 677.525.
  (2) This chapter does not prohibit a student enrolled in an
approved program for educating physician assistants from
rendering medical services if the services are rendered in the
course of the program.
  (3) Notwithstanding subsections (1) and (2) of this section,
the degree of independent judgment that a physician assistant may
exercise shall be determined by the supervising physician { + ,
or supervising physician organization, + } and the physician
assistant in accordance with a practice description approved by
the board.

Enrolled House Bill 3642 (HB 3642-A)                       Page 3

  (4) A physician assistant may provide medical services to
patients in a setting where a supervising physician does not
regularly practice if the following conditions exist:
  (a) Direct communication  { + between the physician assistant
and one or more supervising physicians + } either in person or by
telephone, radio, radiotelephone, television or similar means is
maintained; and
  (b) The medical services provided by the physician assistant
are reviewed by a supervising physician  { + or supervising
physician organization + } on a regularly scheduled basis as
determined by the board.
  (5) A supervising physician, upon the approval of the board and
in accordance with the rules established by the board, may
delegate to the physician assistant the authority to administer
and dispense limited emergency medications and to prescribe
medications pursuant to this section and ORS 677.535 to 677.545.
Neither the board nor the Physician Assistant Committee shall
limit the privilege of administering, dispensing and prescribing
to population groups federally designated as underserved, or to
geographic areas of the state that are federally designated
health professional shortage areas, federally designated
medically underserved areas or areas designated as medically
disadvantaged and in need of primary health care providers by the
Director of the Oregon Health Authority or the Office of Rural
Health. All prescriptions written pursuant to this subsection
shall bear the name, office address and telephone number of the
supervising physician.
  (6) Nothing in this chapter is intended to require or prohibit
a physician assistant from practicing in a hospital licensed
pursuant to ORS 441.015 to 441.089.
  (7) Prescriptions for medications prescribed by a physician
assistant in accordance with this section and ORS 475.005,
677.010, 677.500, 677.510 and 677.535 to 677.545 and dispensed by
a licensed pharmacist may be filled by the pharmacist according
to the terms of the prescription, and the filling of such a
prescription shall not constitute evidence of negligence on the
part of the pharmacist if the prescription was dispensed within
the reasonable and prudent practice of pharmacy.
  SECTION 5. ORS 677.518 is amended to read:
  677.518. A physician assistant, practicing under the
supervision of a   { - person licensed to practice medicine under
this chapter - }   { + supervising physician or a supervising
physician organization + }, is authorized to complete and sign
death certificates. Death certificates signed by a physician
assistant shall be accepted as fulfilling all of the laws dealing
with death certificates. A physician assistant who signs a death
certificate must comply with all provisions of ORS 432.307.
  SECTION 6. ORS 677.535 is amended to read:
  677.535. The Oregon Medical Board may grant a limited license
to a physician assistant if:
  (1) The applicant meets the qualifications of the board, the
application file is complete and no derogatory information has
been submitted but board approval is pending; or
  (2) The physician assistant is changing employment or  { +
changing + } supervising physicians { +  or supervising physician
organizations + }.
  SECTION 7. ORS 677.545 is amended to read:
  677.545. The Physician Assistant Committee shall:
  (1) Review all applications for physician assistants' licensure
and for renewal thereof.

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  (2) Review applications of physician assistants for dispensing
privileges.
  (3) Recommend approval or disapproval of applications submitted
under subsection (1) or (2) of this section to the Oregon Medical
Board.
  (4) Recommend criteria to be used in granting dispensing
privileges under ORS 677.515.
  (5) Recommend the formulary for prescriptive privileges that
may include all or parts of Schedules II, III, IV and V
controlled substances and the procedures for physician assistants
 { - and - }  { + , + } supervising physicians { +  and
supervising physician organizations + } to follow in exercising
the prescriptive privileges.
  (6) Recommend the approval, disapproval or modification of the
application for prescriptive privileges for any physician
assistant. An application for Schedule II controlled substances
prescriptive privileges must be submitted to the Oregon Medical
Board by the physician assistant's supervising physician  { + or
supervising physician organization + } and must be accompanied by
the practice description of the physician assistant. The Schedule
II controlled substances prescriptive privileges of a physician
assistant shall be limited by the practice description approved
by the board and may be restricted further by the supervising
physician  { + or supervising physician organization + } at any
time. The supervising physician  { + or supervising physician
organization + } shall notify the physician assistant and the
board of any additional restrictions imposed by the supervising
physician { +  or supervising physician organization + }, and the
practice description on file with the board shall be amended to
reflect the additional restrictions imposed. To be eligible for
Schedule II controlled substances prescriptive privileges, a
physician assistant must be certified by the National Commission
on Certification of Physician Assistants and must complete all
required continuing medical education coursework.
  SECTION 8. ORS 409.565 is amended to read:
  409.565. A person required to complete one pain management
education program established under ORS 409.510 shall complete
the program:
  (1) Within 24 months of January 2, 2006;
  (2) Within 24 months of the first renewal of the person's
license after January 2, 2006; or
  (3) For a physician assistant for whom an application under ORS
677.510   { - (1) - }  has been approved before January 2, 2006,
within 24 months after January 2, 2006.
  SECTION 9. ORS 743A.044 is amended to read:
  743A.044. (1) An insurer may not refuse a claim solely on the
ground that the claim was submitted by a physician assistant
rather than by   { - the - }   { + a + } supervising physician
for the physician assistant.
  (2) This section is exempt from ORS 743A.001.
  SECTION 10.  { + This 2010 Act being necessary for the
immediate preservation of the public peace, health and safety, an
emergency is declared to exist, and this 2010 Act takes effect on
its passage. + }
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Passed by House February 22, 2010

      ...........................................................
                                             Chief Clerk of House

      ...........................................................
                                                 Speaker of House

Passed by Senate February 23, 2010

      ...........................................................
                                              President of Senate

Enrolled House Bill 3642 (HB 3642-A)                       Page 6

Received by Governor:

......M.,............., 2010

Approved:

......M.,............., 2010

      ...........................................................
                                                         Governor

Filed in Office of Secretary of State:

......M.,............., 2010

      ...........................................................
                                               Secretary of State

Enrolled House Bill 3642 (HB 3642-A)                       Page 7