By Berlanga H.B. No. 2498
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to the regulation of physician assistants; providing a
1-3 criminal penalty.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. SHORT TITLE; LEGISLATIVE FINDINGS AND PURPOSE.
1-6 (a) This Act may be cited as the "Physician Assistants Licensing
1-7 Act."
1-8 (b) The legislature finds that the health, safety, and
1-9 welfare of the people of this state are best advanced by the
1-10 establishment of an orderly system for licensing physician
1-11 assistants. The creation of a licensing mechanism and
1-12 establishment of an entity dedicated to regulating physician
1-13 assistants provides a means to assure the competency of physician
1-14 assistants without a financial burden to the people of this state.
1-15 SECTION 2. DEFINITIONS. In this Act:
1-16 (1) "Board" means the Texas State Board of Medical
1-17 Examiners.
1-18 (2) "Council" means the Physician Assistant Advisory
1-19 Council.
1-20 (3) "Physician assistant" means a person who has
1-21 graduated from a physician assistant or surgeon assistant program
1-22 accredited by the American Medical Association's Committee on
1-23 Allied Health Education and Accreditation or who has passed the
1-24 certifying examination administered by the National Commission on
2-1 Certification of Physician Assistants.
2-2 (4) "Supervising physician" means a medical doctor or
2-3 doctor of osteopathy licensed by the board who supervises a
2-4 physician assistant.
2-5 (5) "Supervision" means overseeing the activities of,
2-6 and accepting responsibility for, the medical services rendered by
2-7 a physician assistant. Supervision does not require the constant
2-8 physical presence of a person providing supervision but includes a
2-9 situation where a person providing supervision and the person being
2-10 supervised are or can easily be in contact with one another by
2-11 radio, telephone, or another telecommunication device.
2-12 SECTION 3. LICENSE REQUIRED. A person may not practice as
2-13 a physician assistant unless the person is licensed under this Act.
2-14 SECTION 4. PHYSICIAN ASSISTANT ADVISORY COUNCIL. (a) The
2-15 Physician Assistant Advisory Council is created as an advisory
2-16 board to the Texas State Board of Medical Examiners.
2-17 (b) The council consists of nine members appointed by the
2-18 governor as follows:
2-19 (1) three members who are physician assistants who
2-20 have at least five years of clinical experience as practicing
2-21 physician assistants;
2-22 (2) three members who are physicians licensed in this
2-23 state who currently supervise physician assistants; and
2-24 (3) three members who are members of the general
2-25 public who are not licensed either as physicians or physician
2-26 assistants.
2-27 (c) A person is not eligible for appointment as a public
3-1 member of the council if the person or the person's spouse:
3-2 (1) is licensed by an occupational regulatory agency
3-3 in the field of health care; or
3-4 (2) is employed by or participates in the management
3-5 of a business entity or other organization that provides health
3-6 care services or that sells, manufactures, or distributes health
3-7 care supplies or equipment.
3-8 (d) Each member of the council is entitled to a per diem as
3-9 set by legislative appropriation for each day that the member
3-10 engages in the business of the council. A member may not receive
3-11 compensation for travel expenses, including expenses for meals and
3-12 lodging, other than transportation expenses. A member is entitled
3-13 to compensation for transportation expenses as provided by the
3-14 General Appropriations Act.
3-15 (e) It is a ground for removal from the council if a member:
3-16 (1) does not have at the time of appointment the
3-17 qualifications required by this section for appointment to the
3-18 council;
3-19 (2) does not maintain during the service on the
3-20 council the qualifications required by this section for appointment
3-21 to the council; or
3-22 (3) fails to attend at least one-half of the regularly
3-23 scheduled council meetings held in a calendar year, excluding
3-24 meetings held while the person was not a committee member.
3-25 (f) A person who is required to register as a lobbyist under
3-26 Chapter 305, Government Code, and its subsequent amendments may not
3-27 serve as a member of the council.
4-1 (g) The validity of an action of the council is not affected
4-2 by the fact that it is taken when a ground for removal of a member
4-3 of the council exists.
4-4 (h) The council is subject to the open meetings law, Chapter
4-5 271, Acts of the 60th Legislature, Regular Session, 1967 (Article
4-6 6252-17, Vernon's Texas Civil Statutes), and its subsequent
4-7 amendments, and the Administrative Procedure and Texas Register Act
4-8 (Article 6252-13a, Vernon's Texas Civil Statutes) and its
4-9 subsequent amendments.
4-10 (i) Members of the council hold office for staggered terms
4-11 of six years expiring February 1 of each odd-numbered year. A
4-12 member is ineligible to serve more than two consecutive full terms
4-13 and may not serve more than a total of three full terms.
4-14 (j) In the case of a vacancy on the council, the governor
4-15 shall appoint a new member to complete an unexpired term.
4-16 (k) The council is subject to Chapter 325, Government Code
4-17 (Texas Sunset Act), and its subsequent amendments. Unless
4-18 continued in existence as provided by that chapter, the council is
4-19 abolished and this Act expires September 1, 2005.
4-20 (l) The council shall select from its membership a presiding
4-21 officer and a secretary to serve for one-year terms.
4-22 (m) Five members of the council constitute a quorum for the
4-23 transaction of the business of the council.
4-24 SECTION 5. POWERS AND DUTIES OF THE COUNCIL. The council
4-25 shall:
4-26 (1) adopt rules as provided by Section 22 of this Act;
4-27 (2) review and approve or reject applications for a
5-1 license;
5-2 (3) review and approve or reject applications for
5-3 renewal of a license;
5-4 (4) issue all licenses;
5-5 (5) deny, suspend, or revoke a license or otherwise
5-6 discipline a license holder;
5-7 (6) prescribe and collect fees authorized under this
5-8 Act; and
5-9 (7) take any action necessary to carry out the
5-10 functions and duties of the council under this Act.
5-11 SECTION 6. FEES. (a) The council shall establish fees that
5-12 are reasonable and necessary to defray the cost of administering
5-13 this Act.
5-14 (b) The council may not maintain unnecessary fund balances,
5-15 and fee amounts shall be set in accordance with this requirement.
5-16 SECTION 7. LICENSE QUALIFICATIONS. The council shall issue
5-17 a license under this Act to an applicant who:
5-18 (1) submits an application on a form prescribed by the
5-19 council;
5-20 (2) pays the application fee as prescribed by the
5-21 council;
5-22 (3) has successfully completed an educational program
5-23 for physician assistants or surgeon assistants accredited by the
5-24 Committee on Allied Health Education and Accreditation or has
5-25 passed the Physician Assistant National Certifying Examination
5-26 administered by the National Commission on Certification of
5-27 Physician Assistants;
6-1 (4) certifies that the applicant is mentally and
6-2 physically able to function safely as a physician assistant;
6-3 (5) does not have a license, certification, or
6-4 registration as a physician assistant in this state or from any
6-5 other licensing authority that is currently revoked or suspended or
6-6 the applicant is not subject to probation or other disciplinary
6-7 action for cause resulting from the applicant's acts as a physician
6-8 assistant, unless the council takes that fact into consideration in
6-9 determining whether to issue the license;
6-10 (6) is of good moral character; and
6-11 (7) submits to the council any other information the
6-12 council considers necessary to evaluate the applicant's
6-13 qualifications.
6-14 SECTION 8. TEMPORARY LICENSE. (a) The council may issue a
6-15 temporary license to an applicant who:
6-16 (1) meets all the qualifications for a license under
6-17 this Act but is waiting for the next scheduled meeting of the
6-18 council for the license to be issued; or
6-19 (2) seeks to temporarily substitute for a licensed
6-20 physician assistant during the licensee's absence, if the
6-21 applicant:
6-22 (A) is licensed or registered in good standing
6-23 in another state, territory, or the District of Columbia;
6-24 (B) submits an application on a form prescribed
6-25 by the council; and
6-26 (C) pays the appropriate fee prescribed by the
6-27 council.
7-1 (b) A temporary license is valid for 45 days from the date
7-2 issued and may be extended only for another 45 days after the date
7-3 the initial temporary license expires.
7-4 SECTION 9. INACTIVE LICENSE. (a) A license holder may have
7-5 the license holder's license placed on inactive status by applying
7-6 to the council. A physician assistant with an inactive license is
7-7 excused from paying renewal fees on the license and may not
7-8 practice as a physician assistant.
7-9 (b) A license holder who practices as a physician assistant
7-10 while on inactive status is considered to be practicing without a
7-11 license.
7-12 (c) A physician assistant may return to active status by
7-13 applying to the council, paying the license renewal fee, and
7-14 complying with the requirements for license renewal under Section
7-15 10 of this Act.
7-16 SECTION 10. RENEWAL. A person who holds a license under
7-17 this Act may, on notification from the council, renew the license
7-18 by:
7-19 (1) paying the renewal fee prescribed by the council;
7-20 (2) submitting the appropriate form; and
7-21 (3) meeting any other requirement established by rules
7-22 adopted by the council.
7-23 SECTION 11. EXEMPTION. This Act does not require a license
7-24 for:
7-25 (1) a physician assistant student enrolled in a
7-26 physician assistant or surgeon assistant educational program
7-27 accredited by the Committee on Allied Health Education and
8-1 Accreditation of the American Medical Association;
8-2 (2) a physician assistant employed in the service of
8-3 the federal government while performing duties related to that
8-4 employment; or
8-5 (3) a technician, assistant, or employee of a
8-6 physician who performs delegated tasks in the office of a physician
8-7 or elsewhere but who does not act as a physician assistant or
8-8 represent that the person is a physician assistant.
8-9 SECTION 12. SCOPE OF PRACTICE. (a) The practice of a
8-10 physician assistant includes medical services within the education,
8-11 training, and experience of the physician assistant that are
8-12 delegated by the supervising physician.
8-13 (b) Medical services provided by a physician assistant may
8-14 include:
8-15 (1) obtaining patient histories and performing
8-16 physical examinations;
8-17 (2) ordering or performing diagnostic and therapeutic
8-18 procedures;
8-19 (3) formulating a working diagnosis;
8-20 (4) developing and implementing a treatment plan;
8-21 (5) monitoring the effectiveness of therapeutic
8-22 interventions;
8-23 (6) assisting at surgery;
8-24 (7) offering counseling and education to patients;
8-25 (8) requesting, receiving, and signing for
8-26 professional samples and distributing the samples to patients at a
8-27 site serving medically underserved populations, as provided by
9-1 Section 3.06(d)(5), Medical Practice Act (Article 4495b, Vernon's
9-2 Texas Civil Statutes), and its subsequent amendments, or as
9-3 otherwise authorized by board rule; and
9-4 (9) making appropriate referrals.
9-5 (c) The activities listed in Subsection (b) of this section
9-6 may be performed in any place authorized by a supervising
9-7 physician, including a clinic, hospital, ambulatory surgical
9-8 center, patient home, nursing home, or other institutional setting.
9-9 SECTION 13. SUPERVISION REQUIREMENTS. (a) Supervision by a
9-10 supervising physician must be continuous but does not require the
9-11 physical presence of the supervising physician at the place where
9-12 physician assistant services are performed while the services are
9-13 performed.
9-14 (b) Each team of a physician and physician assistant must
9-15 ensure that:
9-16 (1) the physician assistant's scope of function is
9-17 identified;
9-18 (2) delegation of medical tasks is appropriate to the
9-19 physician assistant's level of competence;
9-20 (3) the relationship between the members of the team
9-21 and the access of the physician assistant to the supervising
9-22 physician is defined; and
9-23 (4) a process for evaluating the physician assistant's
9-24 performance is established.
9-25 (c) A physician assistant may have more than one supervising
9-26 physician.
9-27 SECTION 14. SUPERVISING PHYSICIAN. A supervising physician
10-1 must:
10-2 (1) be licensed as a physician in this state;
10-3 (2) notify the council of the physician's intent to
10-4 supervise a physician assistant; and
10-5 (3) submit a statement to the council that the
10-6 physician will:
10-7 (A) supervise the physician assistant according
10-8 to rules adopted by the council; and
10-9 (B) retain professional and legal responsibility
10-10 for the care rendered by the physician assistant.
10-11 SECTION 15. NOTIFICATION OF INTENT TO PRACTICE. (a) A
10-12 physician assistant licensed under this Act must, before beginning
10-13 practice, submit on a form prescribed by the council, notification
10-14 of the license holder's intent to begin practice. Notification
10-15 under this section must include:
10-16 (1) the name, business address, license number, and
10-17 telephone number of the physician assistant's supervising
10-18 physician; and
10-19 (2) the name, business address, license number, and
10-20 telephone number of the physician assistant.
10-21 (b) A physician assistant must notify the council of any
10-22 changes in, or additions to, the person acting as a supervising
10-23 physician for the physician assistant not later than the 30th day
10-24 after the date the change or addition is made.
10-25 SECTION 16. EXCLUSION OF LIMITATION ON EMPLOYMENT. This Act
10-26 does not limit the employment arrangement of a physician assistant
10-27 licensed under this Act.
11-1 SECTION 17. ASSUMPTION OF PROFESSIONAL LIABILITY. (a) A
11-2 physician assistant employed by a physician or a group of
11-3 physicians must be supervised by and be the legal responsibility of
11-4 each employing physician. The legal responsibility for the
11-5 physician assistant's patient care activities remains the
11-6 responsibility of the employing physician, including when the
11-7 physician assistant provides care and treatment for a patient in a
11-8 health care facility.
11-9 (b) A health care facility or other entity that employs a
11-10 physician assistant has the legal responsibility for the physician
11-11 assistant's acts or omissions. A physician assistant employed by a
11-12 health care facility or other entity shall be supervised by a
11-13 licensed physician.
11-14 SECTION 18. DISCIPLINARY PROCEEDINGS. The council may
11-15 refuse to issue a license, publicly or privately reprimand a
11-16 license holder, or suspend, revoke, or place other restrictions on
11-17 a license of a person who:
11-18 (1) fraudulently or deceptively obtains or attempts to
11-19 obtain a license;
11-20 (2) fraudulently or deceptively uses a license;
11-21 (3) violates any provision of this Act or any rule
11-22 adopted under this Act;
11-23 (4) is convicted of a felony;
11-24 (5) is a habitual user of intoxicants or
11-25 nontherapeutic drugs to the extent that the person cannot safely
11-26 perform as a physician assistant;
11-27 (6) has been adjudicated as mentally incompetent or
12-1 has a mental condition that renders the person unable to safely
12-2 perform as a physician assistant;
12-3 (7) has committed an act of moral turpitude; or
12-4 (8) represents that the person is a physician.
12-5 SECTION 19. ADDITIONAL DISCIPLINARY AUTHORITY. In addition
12-6 to the authority under Section 18 of this Act, the council may, on
12-7 finding that a physician assistant has committed an offense
12-8 described in Section 18 of this Act:
12-9 (1) require a physician assistant to submit to the
12-10 care, counseling, or treatment of a physician designated by the
12-11 council;
12-12 (2) stay enforcement of an order and place the
12-13 physician assistant on probation with the council retaining the
12-14 right to vacate the probationary stay and enforce the original
12-15 order for noncompliance with the terms of probation;
12-16 (3) restore or reissue a license or remove any
12-17 disciplinary or corrective measure that the council may have
12-18 imposed;
12-19 (4) order the physician assistant to perform public
12-20 service; or
12-21 (5) require the physician assistant to complete
12-22 additional training.
12-23 SECTION 20. OFFENSE. (a) A person commits an offense if,
12-24 without holding a license under this Act, the person:
12-25 (1) holds the person out as a physician assistant;
12-26 (2) uses any combination or abbreviation of the term
12-27 "physician assistant" to indicate or imply that the person is a
13-1 physician assistant; or
13-2 (3) acts as a physician assistant without being
13-3 licensed by the council.
13-4 (b) An offense under this section is a felony of the third
13-5 degree.
13-6 SECTION 21. IDENTIFICATION REQUIREMENTS. A physician
13-7 assistant licensed under this Act shall:
13-8 (1) keep the physician assistant's license available
13-9 for inspection at the physician assistant's primary place of
13-10 business; and
13-11 (2) when engaged in the physician assistant's
13-12 professional activities, wear a name tag identifying the physician
13-13 assistant as a physician assistant.
13-14 SECTION 22. RULE-MAKING AUTHORITY. (a) The council shall
13-15 adopt rules that are reasonable and necessary for the performance
13-16 of the council's duties under this Act, as provided by the
13-17 Administrative Procedure and Texas Register Act (Article 6252-13a,
13-18 Vernon's Texas Civil Statutes), and its subsequent amendments,
13-19 including rules:
13-20 (1) setting licensing and other fees;
13-21 (2) establishing renewal dates for licenses; and
13-22 (3) establishing rules and procedures for disciplinary
13-23 actions.
13-24 (b) Rules adopted by the council must be:
13-25 (1) approved or rejected by a majority vote of the
13-26 board; and
13-27 (2) if rejected, returned to the council for revision.
14-1 SECTION 23. RURAL PHYSICIAN ASSISTANT LOAN REIMBURSEMENT
14-2 PROGRAM. (a) A portion of the revenue generated under this Act
14-3 from physician assistant licensing fees shall be set aside to
14-4 provide student loan reimbursement for graduates of physician
14-5 assistant training programs in this state who practice in rural
14-6 health professional shortage areas identified by the board.
14-7 (b) The loan program shall be administered by the Center for
14-8 Rural Health Initiatives.
14-9 SECTION 24. CONFORMING AMENDMENT. Section
14-10 3.06(d)(5)(D)(ii), Medical Practice Act (Article 4495b, Vernon's
14-11 Texas Civil Statutes), is amended to read as follows:
14-12 (ii) "Physician assistant" has the meaning
14-13 assigned to that term by Section 2(3), Physician Assistants
14-14 Licensing Act, and its subsequent amendments <means a physician
14-15 assistant recognized by the Board of Medical Examiners as having
14-16 the specialized education and training required under Subsection
14-17 (d), Section 5.02 of this Act>.
14-18 SECTION 25. CONFORMING AMENDMENT. Section 110.001(3), Civil
14-19 Practice and Remedies Code, is amended to read as follows:
14-20 (3) "Health care professional" means:
14-21 (A) a person who is licensed to practice
14-22 medicine under the Medical Practice Act (Article 4495b, Vernon's
14-23 Texas Civil Statutes);
14-24 (B) a person registered by the Board of Nurse
14-25 Examiners as an advanced nurse practitioner or a certified nurse
14-26 midwife; or
14-27 (C) a person licensed <recognized> by the
15-1 Physician Assistant Advisory Council under the Texas State Board of
15-2 Medical Examiners as a physician assistant.
15-3 SECTION 26. TRANSITION. (a) A person is not required to
15-4 obtain a license under this Act until September 1, 1994.
15-5 (b) The council shall adopt rules under this Act not later
15-6 than January 1, 1994.
15-7 (c) In making the initial appointments to the council, the
15-8 governor shall designate three members for terms expiring February
15-9 1, 1995, three members for terms expiring February 1, 1997, and
15-10 three members for terms expiring February 1, 1999.
15-11 (d) The physician assistants advisory committee created
15-12 under Section 5.02(c), Medical Practice Act (Article 4495b,
15-13 Vernon's Texas Civil Statutes), is abolished on the effective date
15-14 of this Act.
15-15 SECTION 27. REPEALER. Sections 5.02(c) and (d), Medical
15-16 Practice Act (Article 4495b, Vernon's Texas Civil Statutes), are
15-17 repealed.
15-18 SECTION 28. EFFECTIVE DATE. This Act takes effect September
15-19 1, 1993, except that Sections 3 and 20 take effect September 1,
15-20 1994.
15-21 SECTION 29. EMERGENCY. The importance of this legislation
15-22 and the crowded condition of the calendars in both houses create an
15-23 emergency and an imperative public necessity that the
15-24 constitutional rule requiring bills to be read on three several
15-25 days in each house be suspended, and this rule is hereby suspended.