Bill Text: CA AB2194 | 2023-2024 | Regular Session | Introduced
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Physician assistants: supervision: doctors of podiatric medicine.
Spectrum: Partisan Bill (Republican 2-0)
Status: (Engrossed) 2024-05-21 - In Senate. Read first time. To Com. on RLS. for assignment. [AB2194 Detail]
Download: California-2023-AB2194-Introduced.html
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
or podiatrist
is available to supervise the physician assistant, so long as a licensed physician or podiatrist is available to render the appropriate supervision. “Appropriate supervision” shall not require the personal or electronic availability of a supervising physician or podiatrist 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. a the following:
Bill Title: Physician assistants: supervision: doctors of podiatric medicine.
Spectrum: Partisan Bill (Republican 2-0)
Status: (Engrossed) 2024-05-21 - In Senate. Read first time. To Com. on RLS. for assignment. [AB2194 Detail]
Download: California-2023-AB2194-Introduced.html
CALIFORNIA LEGISLATURE—
2023–2024 REGULAR SESSION
Assembly Bill
No. 2194
| Introduced by Assembly Member Joe Patterson |
February 07, 2024 |
An act to amend Sections 3500, 3501, 3502, 3502.1, 3502.3, 3502.5, 3503.5, and 3516 of, and to add Section 3502.7 to, the Business and Professions Code, relating to healing arts.
LEGISLATIVE COUNSEL'S DIGEST
AB 2194, as introduced, Joe Patterson.
Physician assistants: supervision: podiatrists.
Existing law, the Physician Assistant Practice Act, establishes the Physician Assistant Board for the licensure and regulation of physician assistants. Existing law authorizes physician assistants to perform prescribed medical services that are rendered pursuant to a practice agreement and under the supervision of a licensed physician and surgeon. A violation of that supervision provision is a crime.
Existing law defines, for purposes of the act, the terms “supervising physician” and “supervising physician and surgeon” to mean 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.
Existing law, the Medical Practice Act, provides for the certification and regulation of podiatrists by the Podiatric Medical Board of California, which is within the Department of Consumer Affairs. Existing law authorizes physicians and surgeons and doctors of podiatric medicine to establish a professional partnership that includes both physicians and surgeons and doctors of podiatric medicine if specified conditions are satisfied.
Existing law authorizes a physician assistant performing medical services under the supervision of a physician and surgeon to assist a doctor of podiatric medicine who is a partner, shareholder, or employee in the same medical group as the supervising physician and surgeon. Existing law requires a physician assistant who assists a doctor of podiatric medicine in this manner to do so only according to patient-specific orders from a supervising physician and surgeon and limits the physician assistant to
performing those duties included within the scope of practice of a doctor of podiatric medicine. Existing law requires a supervising physician and surgeon to be available to the physician assistant for consultation when assistance is rendered.
This bill would delete these provisions establishing the conditions under which a physician assistant may assist a doctor of podiatric medicine and, instead, would expand the existing supervising physician and surgeon provisions to authorize a supervising podiatrist, as defined, to supervise a physician assistant in a similar manner. The bill would limit a physician assistant assisting a doctor of podiatric medicine pursuant to these expanded provisions to performing those duties included within the scope of practice of a doctor of podiatric medicine. The bill would make conforming changes.
Under existing law, a physician assistant licensed by the board is eligible for employment or
supervision by a physician and surgeon who is not subject to a disciplinary condition imposed by the Medical Board of California prohibiting that employment or supervision. Existing law, except as specified, prohibits a physician and surgeon from supervising more than 4 physician assistants at any one time. Existing law authorizes the Medical Board of California to 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. A violation of these supervision provisions is a crime.
This bill would expand these physician assistant supervision provisions to podiatrists and the Podiatric Medical Board of California.
By expanding certain of the above supervision provisions, the violation of which is a crime, the bill would impose 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: YESBill 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.
(a) 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 another category of health manpower—the physician assistant. The
(b) The purpose of this chapter is to encourage the effective
utilization of the skills of physicians and surgeons, and physicians and surgeons and podiatrists practicing in the same medical group practice, by enabling them to work with qualified physician assistants to provide quality care.
This
(c) This
chapter is established to encourage the coordinated care between physician assistants, physicians and surgeons, podiatrists, and other qualified health care providers practicing in the same medical group, and to provide 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.
As used in this chapter:(a) “Board” means the Physician Assistant Board.
(b) “Approved program” means a program for the education of physician assistants that has been formally approved by the board.
(c) “Trainee” means a person who is currently enrolled in an approved program.
(d) “Physician assistant” or “PA” means a person who meets the requirements of this chapter and is licensed by the board.
(e) “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 prohibiting the employment or supervision of a physician assistant.
(f) “Supervising podiatrist” means a podiatrist licensed by the Podiatric Medical Board of California who supervises one or more physician assistants, who possesses a current valid license to practice podiatric medicine, and who is not currently on disciplinary probation prohibiting the employment or supervision of a physician assistant.
(f)
(g) (1) “Supervision” means that a licensed physician and surgeon
podiatrist oversees the activities of, and accepts responsibility for, the medical services rendered by a physician assistant. Supervision, as defined in this subdivision, shall not be construed to require the physical presence of the physician and surgeon, surgeon or podiatrist, but does require the following:
(A) Adherence to adequate supervision as agreed to in the practice agreement.
(B) The physician and surgeon or podiatrist being available by telephone or other electronic communication method at the time the PA examines the patient.
(2) Nothing in this subdivision shall be construed as prohibiting the board from requiring the physical presence of a physician and surgeon or podiatrist as a term or condition of a PA’s reinstatement, probation, or imposing discipline.
(g)
(h) “Regulations” means the rules and regulations as set forth in Division 13.8 (commencing with Section 1399.500) of Title 16 of the California Code of Regulations.
(h)
(i) “Routine visual screening” means noninvasive, nonpharmacological simple testing for visual acuity, visual field defects, color blindness, and depth perception.
(i)
(j) “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.
(j)
(k) “Organized health care system” includes a licensed clinic as described in Chapter 1 (commencing with Section 1200) of Division 2 of the Health and Safety Code, an outpatient setting as described in Chapter 1.3 (commencing with Section 1248) of Division 2 of the Health and Safety Code, a health facility as described in Chapter 2 (commencing with Section 1250) of Division 2 of the Health and Safety Code, a county medical facility as described in Chapter 2.5 (commencing with Section 1440) of Division 2 of the Health and Safety Code, an accountable care organization, a home health agency, a physician’s office, a professional medical corporation, a medical partnership, a medical foundation, and any other entity that lawfully provides medical services and is in compliance with Article 18 (commencing with Section 2400) of Chapter 5.
(k)
(l) “Practice agreement” means the writing, developed through collaboration among one or more physicians and surgeons or podiatrists and one or more physician assistants, that defines the medical services the physician assistant is authorized to perform pursuant to Section 3502 and that grants approval for physicians and surgeons or podiatrists on the staff of an organized health care system to supervise one or more physician assistants in the organized health care system. Any reference to a delegation of services agreement relating to physician assistants in any other law shall have the same meaning as a practice agreement.
(l)
(m) “Other specified medical services” means tests or examinations performed or ordered by a PA practicing in compliance with this chapter or regulations of the board or the Medical Board of California promulgated under this chapter.
SEC. 3.
Section 3502 of the Business and Professions Code is amended to read:3502.
(a) Notwithstanding any other law, a PA may perform medical services as authorized by this chapter if the following requirements are met:(1) The PA renders the services under the supervision of a licensed physician and surgeon who is not subject to a disciplinary condition imposed by the Medical Board of California or by the Osteopathic Medical Board of California California, or under the supervision of a podiatrist who is not subject to a disciplinary condition imposed by the Podiatric Medical Board of California, prohibiting that supervision or prohibiting the employment of a
physician assistant.
(2) The PA renders the services pursuant to a practice agreement that meets the requirements of Section 3502.3.
(3) The PA is competent to perform the services.
(4) The PA’s education, training, and experience have prepared the PA to render the services.
(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 a supervising physician and surgeon.
(2)A supervising physician and surgeon shall be available to the physician assistant for consultation when assistance is rendered pursuant to this subdivision. 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)
(b) Nothing in regulations shall require that a physician and surgeon or podiatrist review or countersign a medical record of a patient treated by a physician assistant, unless required by the practice agreement. The board may,
board, as a condition of probation or reinstatement of a licensee, may require the review or countersignature of records of patients treated by a physician assistant for a specified duration.
(d)
(c) This chapter does not authorize the performance of medical services 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)
(d) This section shall not be construed in a manner that shall preclude the performance of
routine visual screening as defined in Section 3501.
(f)
(e) Notwithstanding any other law, a PA rendering services in a general acute care hospital as defined in Section 1250 of the Health and Safety Code shall be supervised by a physician and surgeon or podiatrist with privileges to practice in that hospital. Within a general acute care hospital, the practice agreement shall establish policies and procedures to identify a physician and surgeon or podiatrist who
is supervising the PA.
SEC. 4.
Section 3502.1 of the Business and Professions Code is amended to read:3502.1.
In addition to the medical services authorized in the regulations adopted pursuant to Section 3502, and except as prohibited by Section 3502, a PA may furnish or order a drug or device subject to all of the following:(a) The PA shall furnish or order a drug or device in accordance with the practice agreement and consistent with the PA’s educational preparation or for which clinical competency has been established and maintained.
(b) (1) A practice agreement authorizing a PA to order or furnish a drug or device shall specify which PA or PAs may furnish or order a drug or device, which drugs or devices may be furnished or ordered, under what circumstances, the extent of physician and surgeon
or podiatrist
supervision, the method of periodic review of the PA’s competence, including peer review, and review of the practice agreement.
(2) In addition to the requirements in paragraph (1), if the practice agreement authorizes the PA to furnish a Schedule II controlled substance, the practice agreement shall address the diagnosis of the illness, injury, or condition for which the PA may furnish the Schedule II controlled substance.
(c) The PA shall furnish or order drugs or devices under physician and surgeon or podiatrist supervision. This subdivision shall not be construed to require the physical presence of the physician and surgeon,
surgeon or podiatrist, but does require the following:
(1) Adherence to adequate supervision as agreed to in the practice agreement.
(2) The physician and surgeon or podiatrist be available by telephone or other electronic communication method at the time the PA examines the patient.
(d) (1) Except as provided in paragraph (2), the PA may furnish or order only those Schedule II through Schedule V controlled substances under the California Uniform Controlled Substances Act (Division 10 (commencing with Section 11000) of the Health and Safety Code) that have been agreed upon in the practice agreement.
(2) The PA may furnish or order Schedule II or III controlled substances, as defined in Sections 11055 and 11056, respectively, of the Health and Safety Code, in accordance with the practice agreement or a patient-specific order approved by the treating or supervising physician and surgeon. surgeon or podiatrist.
(e) (1) The PA has satisfactorily completed a course in pharmacology covering the drugs or devices to be furnished or ordered under this section or has completed a program for instruction of PAs that meet the requirements of Section 1399.530 of Title 16 of the California Code of Regulations, as that provision read on June 7, 2019.
(2) A physician
and surgeon or podiatrist through a practice agreement may determine the extent of supervision necessary pursuant to this section in the furnishing or ordering of drugs and devices.
(3) PAs who hold an active license, who are authorized through a practice agreement to furnish Schedule II controlled substances, and who are registered with the United States Drug Enforcement Administration, and who have not successfully completed a one-time course in compliance with Sections 1399.610 and 1399.612 of Title 16 of the California Code of Regulations, as those provisions read on June 7, 2019, shall complete, as part of their continuing education requirements, a course that covers Schedule II controlled substances, and the risks of addiction associated with their use, based on the standards developed by the board. The board shall establish the
requirements for satisfactory completion of this subdivision. Evidence of completion of a course meeting the standards, including pharmacological content, established in Sections 1399.610 and 1399.612 of Title 16 of the California Code of Regulations, as those provisions read on June 7, 2019, shall be deemed to meet the requirements of this section.
(f) For purposes of this section:
(1) “Furnishing” or “ordering” shall include the following:
(A) Ordering a drug or device in accordance with the practice agreement.
(B) Transmitting an order of a supervising physician and surgeon. surgeon or
podiatrist.
(C) Dispensing a medication pursuant to Section 4170.
(2) “Drug order” or “order” means an order for medication that is dispensed to or for an ultimate user, issued by a PA as an individual practitioner, within the meaning of Section 1306.02 of Title 21 of the Code of Federal Regulations.
(g) Notwithstanding any other law, (1) a drug order issued pursuant to this section shall be treated in the same manner as a prescription of a supervising physician;
physician or podiatrist; (2) all references to “prescription” in this code and the Health and Safety Code shall include drug orders issued by physician assistants; and (3) the signature of a PA on a drug order issued in accordance with this section shall be deemed to be the signature of a prescriber for purposes of this code and the Health and Safety Code.
SEC. 5.
Section 3502.3 of the Business and Professions Code is amended to read:3502.3.
(a) (1) A practice agreement shall include provisions that address the following:(A) The types of medical services a physician assistant is authorized to perform.
(B) Policies and procedures to ensure adequate supervision of the physician assistant, including, but not limited to, appropriate communication, availability, consultations, and referrals between a physician and surgeon or podiatrist and the physician assistant in the provision of medical services.
(C) The methods for the continuing evaluation of
the competency and qualifications of the physician assistant.
(D) The furnishing or ordering of drugs or devices by a physician assistant pursuant to Section 3502.1.
(E) Any additional provisions agreed to by the physician assistant and physician and surgeon. surgeon or podiatrist.
(2) A practice agreement shall be signed by both of the following:
(A) The physician assistant.
(B) One or more physicians and surgeons or
podiatrists or a physician and surgeon or podiatrist who is authorized to approve the practice agreement on behalf of the staff of the physicians and surgeons
or podiatrists on the staff of an organized health care system.
(3) A delegation of services agreement in effect prior to January 1, 2020, shall be deemed to meet the requirements of this subdivision.
(4) A practice agreement may designate a PA as an agent of a supervising physician and surgeon. surgeon or podiatrist.
(5) Nothing in this section shall be construed to require approval of a practice agreement by the board.
(b) Notwithstanding any other law, in addition to any other practices that meet the general criteria set
forth in this chapter or regulations adopted by the board or the Medical Board of California, a practice agreement may authorize a PA to do any of the following:
(1) Order durable medical equipment, subject to any limitations set forth in Section 3502 or the practice agreement. Notwithstanding that authority, nothing in this paragraph shall operate to limit the ability of a third-party payer to require prior approval.
(2) For individuals receiving home health services or personal care services, after consultation with a supervising physician and surgeon, approve, sign, modify, or add to a plan of treatment or plan of care.
(3) After performance of a physical examination by the PA under the supervision of a physician and surgeon or
podiatrist consistent with this chapter, 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.
(c) This section shall not be construed to affect the validity of any practice agreement in effect prior to the effective date of this section or those adopted subsequent to the effective date of this section.
SEC. 6.
Section 3502.5 of the Business and Professions Code is amended to read:3502.5.
(a) Notwithstanding any other No
(b) A responsible official or mutual aid operation plan shall not invoke this 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 3502.7 is added to the Business and Professions Code, to read:3502.7.
A physician assistant assisting a doctor of podiatric medicine pursuant to this chapter shall be limited to performing those duties included within the scope of practice of a doctor of podiatric medicine.SEC. 8.
Section 3503.5 of the Business and Professions Code is amended to read:3503.5.
(a) A person licensed under this chapter who in good faith renders emergency care at the scene of an emergency that occurs outside both the place and course of that person’s employment shall not be liable for any civil damage as a result of any acts or omissions by that person in rendering the emergency care.(b) This section shall not be construed to grant immunity from civil damages to any person whose conduct in rendering emergency care is grossly negligent.
(c) In addition to the immunity specified in subdivision (a), the provisions of Article 17 (commencing with Section
2395) of Chapter 5 shall apply to a person licensed under this chapter when acting pursuant to delegated authority from an approved supervising physician. physician or podiatrist.
SEC. 9.
Section 3516 of the Business and Professions Code is amended to read:3516.
(a) Notwithstanding any other law, a physician assistant licensed by the board shall be eligible for employment or supervision by(1) A physician and surgeon who is not subject to a disciplinary condition imposed by the Medical Board of California prohibiting that employment or supervision.
(2) A podiatrist who is not subject to a disciplinary condition imposed by the Podiatric Medical Board of California prohibiting that employment or supervision.
(b) (1) Except as provided in paragraph (2) and in Section 3502.5, a physician and surgeon or a podiatrist shall not supervise more than four physician assistants at any one time.
(2) Notwithstanding paragraph (1), a physician and surgeon may supervise up to, but no more than, eight physician assistants at one time, but only if the following conditions are satisfied by all supervised physician assistants:
(A) The physician assistants are focused
solely on performing in home health evaluations.
(B) The physician assistants are performing in home health evaluations solely for the following purposes:
(i) Gathering patient information.
(ii) Performing an annual wellness visit or health evaluation, if it does not involve direct patient treatment or prescribing medication.
(3) A physician assistant who performs an in home health evaluation for the purposes specified in subparagraph (B) of paragraph (2) remains subject to all supervisory and scope requirements pursuant to this chapter and shall provide the supervising physician and surgeon with all information related to their evaluation under subparagraphs (A) and (B) of paragraph (2).
(c) (1) The Medical Board of California may restrict a physician and surgeon to supervising specific types of physician assistants 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.
(2) The Podiatric Medical Board of California may restrict a podiatrist to supervising specific types of physician assistants, including, but not limited to, restricting a podiatrist from supervising physician assistants outside
of the field of specialty of the podiatrist.
(d) For purposes of this section:
(1) “In home health evaluation” means a comprehensive physical exam, assessment of current and prior health conditions, a complete medication review, screening tests, health education, and assessment of social determination of health needs to be used for diagnosing individual medical conditions.
(2) “Annual wellness visit” means a preventive visit with correlating current procedural terminology codes performed annually to a patient, to be used for the purposes of diagnosing patient conditions during the annual wellness visit, which may include a nonphysical examination for patients covered by Medicare Part B for more than 12 months.
