H.B. No. 2498
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 Assistant 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 ensure 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 a
2-13 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 currently legally practicing
2-20 as physician assistants and who have at least five years of
2-21 clinical experience as practicing 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 by that
5-25 committee's predecessor or successor entities or has passed the
5-26 Physician Assistant National Certifying Examination administered by
5-27 the National Commission on Certification of 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;
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; or
8-9 (4) any other licensed health care worker acting
8-10 within the scope of that person's license if the person does not
8-11 use the title "physician assistant" or "P.A." or is not represented
8-12 or designated as a physician assistant.
8-13 SECTION 12. SCOPE OF PRACTICE. (a) The practice of a
8-14 physician assistant includes medical services within the education,
8-15 training, and experience of the physician assistant that are
8-16 delegated by the supervising physician.
8-17 (b) Medical services provided by a physician assistant may
8-18 include:
8-19 (1) obtaining patient histories and performing
8-20 physical examinations;
8-21 (2) ordering or performing diagnostic and therapeutic
8-22 procedures;
8-23 (3) formulating a working diagnosis;
8-24 (4) developing and implementing a treatment plan;
8-25 (5) monitoring the effectiveness of therapeutic
8-26 interventions;
8-27 (6) assisting at surgery;
9-1 (7) offering counseling and education to patients;
9-2 (8) requesting, receiving, and signing for
9-3 professional samples and distributing the samples to patients at a
9-4 site serving medically underserved populations, as provided by
9-5 Section 3.06(d)(5), Medical Practice Act (Article 4495b, Vernon's
9-6 Texas Civil Statutes), and its subsequent amendments, or as
9-7 otherwise authorized by board rule; and
9-8 (9) making appropriate referrals.
9-9 (c) The activities listed in Subsection (b) of this section
9-10 may be performed in any place authorized by a supervising
9-11 physician, including a clinic, hospital, ambulatory surgical
9-12 center, patient home, nursing home, or other institutional setting.
9-13 SECTION 13. SUPERVISION REQUIREMENTS. (a) Supervision by a
9-14 supervising physician must be continuous but does not require the
9-15 physical presence of the supervising physician at the place where
9-16 physician assistant services are performed while the services are
9-17 performed.
9-18 (b) Each team of a physician and physician assistant must
9-19 ensure that:
9-20 (1) the physician assistant's scope of function is
9-21 identified;
9-22 (2) delegation of medical tasks is appropriate to the
9-23 physician assistant's level of competence;
9-24 (3) the relationship between the members of the team
9-25 and the access of the physician assistant to the supervising
9-26 physician is defined; and
9-27 (4) a process for evaluating the physician assistant's
10-1 performance is established.
10-2 (c) A physician assistant may have more than one supervising
10-3 physician.
10-4 SECTION 14. SUPERVISING PHYSICIAN. A supervising physician
10-5 must:
10-6 (1) be licensed as a physician in this state;
10-7 (2) notify the council of the physician's intent to
10-8 supervise a physician assistant; and
10-9 (3) submit a statement to the council that the
10-10 physician will:
10-11 (A) supervise the physician assistant according
10-12 to rules adopted by the council; and
10-13 (B) retain professional and legal responsibility
10-14 for the care rendered by the physician assistant.
10-15 SECTION 15. NOTIFICATION OF INTENT TO PRACTICE. (a) A
10-16 physician assistant licensed under this Act must, before beginning
10-17 practice, submit on a form prescribed by the council notification
10-18 of the license holder's intent to begin practice. Notification
10-19 under this section must include:
10-20 (1) the name, business address, license number, and
10-21 telephone number of the physician assistant's supervising
10-22 physician; and
10-23 (2) the name, business address, license number, and
10-24 telephone number of the physician assistant.
10-25 (b) A physician assistant must notify the council of any
10-26 changes in, or additions to, the person acting as a supervising
10-27 physician for the physician assistant not later than the 30th day
11-1 after the date the change or addition is made.
11-2 SECTION 16. EXCLUSION OF LIMITATION ON EMPLOYMENT. This Act
11-3 does not limit the employment arrangement of a physician assistant
11-4 licensed under this Act.
11-5 SECTION 17. ASSUMPTION OF PROFESSIONAL LIABILITY. (a) A
11-6 physician assistant employed by a physician or a group of
11-7 physicians must be supervised by and be the legal responsibility of
11-8 each employing physician. The legal responsibility for the
11-9 physician assistant's patient care activities remains the
11-10 responsibility of the employing physician, including when the
11-11 physician assistant provides care and treatment for a patient in a
11-12 health care facility.
11-13 (b) A physician assistant employed by a health care facility
11-14 or other entity shall be supervised by a licensed physician. A
11-15 health care facility or other entity that employs a physician
11-16 assistant shares the legal responsibility for the physician
11-17 assistant's acts or omissions with the physician assistant's
11-18 supervising physician.
11-19 SECTION 18. DISCIPLINARY PROCEEDINGS. The council may
11-20 refuse to issue a license, publicly or privately reprimand a
11-21 license holder, or suspend, revoke, or place other restrictions on
11-22 a license of a person who:
11-23 (1) fraudulently or deceptively obtains or attempts to
11-24 obtain a license;
11-25 (2) fraudulently or deceptively uses a license;
11-26 (3) violates any provision of this Act or any rule
11-27 adopted under this Act;
12-1 (4) is convicted of a felony;
12-2 (5) is a habitual user of intoxicants or
12-3 nontherapeutic drugs to the extent that the person cannot safely
12-4 perform as a physician assistant;
12-5 (6) has been adjudicated as mentally incompetent or
12-6 has a mental condition that renders the person unable to safely
12-7 perform as a physician assistant;
12-8 (7) has committed an act of moral turpitude; or
12-9 (8) represents that the person is a physician.
12-10 SECTION 19. ADDITIONAL DISCIPLINARY AUTHORITY. In addition
12-11 to the authority under Section 18 of this Act, the council may, on
12-12 finding that a physician assistant has committed an offense
12-13 described in Section 18 of this Act:
12-14 (1) require a physician assistant to submit to the
12-15 care, counseling, or treatment of a physician designated by the
12-16 council;
12-17 (2) stay enforcement of an order and place the
12-18 physician assistant on probation with the council retaining the
12-19 right to vacate the probationary stay and enforce the original
12-20 order for noncompliance with the terms of probation;
12-21 (3) restore or reissue a license or remove any
12-22 disciplinary or corrective measure that the council may have
12-23 imposed;
12-24 (4) order the physician assistant to perform public
12-25 service; or
12-26 (5) require the physician assistant to complete
12-27 additional training.
13-1 SECTION 20. OFFENSE. (a) A person commits an offense if,
13-2 without holding a license under this Act, the person:
13-3 (1) holds the person out as a physician assistant;
13-4 (2) uses any combination or abbreviation of the term
13-5 "physician assistant" to indicate or imply that the person is a
13-6 physician assistant; or
13-7 (3) acts as a physician assistant without being
13-8 licensed by the council.
13-9 (b) An offense under this section is a felony of the third
13-10 degree.
13-11 SECTION 21. IDENTIFICATION REQUIREMENTS. A physician
13-12 assistant licensed under this Act shall:
13-13 (1) keep the physician assistant's license available
13-14 for inspection at the physician assistant's primary place of
13-15 business; and
13-16 (2) when engaged in the physician assistant's
13-17 professional activities, wear a name tag identifying the physician
13-18 assistant as a physician assistant.
13-19 SECTION 22. RULE-MAKING AUTHORITY. (a) The council shall
13-20 adopt rules that are reasonable and necessary for the performance
13-21 of the council's duties under this Act, as provided by the
13-22 Administrative Procedure and Texas Register Act (Article 6252-13a,
13-23 Vernon's Texas Civil Statutes), and its subsequent amendments,
13-24 including rules:
13-25 (1) setting licensing and other fees;
13-26 (2) establishing renewal dates for licenses; and
13-27 (3) establishing rules and procedures for disciplinary
14-1 actions.
14-2 (b) Rules adopted by the council must:
14-3 (1) be approved or rejected by a majority vote of the
14-4 board; and
14-5 (2) if rejected, be returned to the council for
14-6 revision.
14-7 SECTION 23. RURAL PHYSICIAN ASSISTANT LOAN REIMBURSEMENT
14-8 PROGRAM. (a) The council shall designate annually a portion of
14-9 the revenue generated under this Act from physician assistant
14-10 licensing fees to be set aside to provide student loan
14-11 reimbursement for graduates of physician assistant training
14-12 programs in this state who practice in rural health professional
14-13 shortage areas identified by the Texas Department of Health.
14-14 (b) The Center for Rural Health Initiatives shall establish
14-15 policies for and adopt rules to administer the loan program under
14-16 this section.
14-17 (c) The council shall authorize and the board shall transfer
14-18 annually the funds designated in Subsection (a) of this section to
14-19 the Center for Rural Health Initiatives to administer the loan
14-20 program under this section.
14-21 SECTION 24. CONFORMING AMENDMENT. Section
14-22 3.06(d)(5)(D)(ii), Medical Practice Act (Article 4495b, Vernon's
14-23 Texas Civil Statutes), is amended to read as follows:
14-24 (ii) "Physician assistant" has the meaning
14-25 assigned to that term by Section 2(3), Physician Assistant
14-26 Licensing Act, and its subsequent amendments <means a physician
14-27 assistant recognized by the Board of Medical Examiners as having
15-1 the specialized education and training required under Subsection
15-2 (d), Section 5.02 of this Act>.
15-3 SECTION 25. CONFORMING AMENDMENT. Section 3.10(b), Medical
15-4 Practice Act (Article 4495b, Vernon's Texas Civil Statutes), is
15-5 amended to read as follows:
15-6 (b) The board may not set, charge, collect, receive, or
15-7 deposit any of the following fees in excess of:
15-8 (1) for processing and granting a license by
15-9 reciprocity to a licensee of another state ................... $700
15-10 (2) for processing an application and administration
15-11 of a partial examination for licensure ....................... $700
15-12 (3) for processing an application and administration
15-13 of a complete examination for licensure ...................... $700
15-14 (4) for processing an application and issuance of a
15-15 temporary license ............................................ $200
15-16 (5) for processing an application and issuance of a
15-17 duplicate license ............................................ $200
15-18 (6) for processing an application and issuance of a
15-19 license of reinstatement after a lapse or cancellation of a
15-20 license ...................................................... $700
15-21 (7) for processing an application and issuance of an
15-22 annual registration of a licensee ............................ $200
15-23 (8) for processing and issuance of an institutional
15-24 permit for interns, residents, and others in approved medical
15-25 training programs ............................................ $200
15-26 (9) for processing an application and issuance of an
15-27 endorsement to other state medical boards .................... $200
16-1 (10) for processing and issuance of a license or
16-2 temporary license <permit> to a <physician who supervises a>
16-3 physician assistant .......................................... $200
16-4 (11) for processing and issuance of a permit to a
16-5 physician who supervises an acupuncturist .................. $200.
16-6 SECTION 26. CONFORMING AMENDMENT. Section 5.02, Medical
16-7 Practice Act (Article 4495b, Vernon's Texas Civil Statutes), is
16-8 amended to read as follows:
16-9 Sec. 5.02. Supervision of Physician Assistants. <(a)> The
16-10 board <by rule> shall adopt rules to regulate physician assistants
16-11 and physicians who supervise physician assistants that are
16-12 consistent with the Physician Assistant Licensing Act and its
16-13 subsequent amendments. <standards to regulate the extent to which a
16-14 physician licensed by the board may delegate his responsibilities
16-15 as a physician to a physician assistant. The standards shall take
16-16 into consideration:>
16-17 <(1) the skill of the physician assistant to whom the
16-18 physician is to delegate the responsibility;>
16-19 <(2) the skill of the physician who is to delegate the
16-20 responsibility;>
16-21 <(3) the nature of the responsibility delegated;>
16-22 <(4) the extent and nature of the supervision that the
16-23 physician is to give to the physician assistant to whom the
16-24 responsibility is delegated;>
16-25 <(5) the risks to the patient who is the subject of
16-26 the delegated responsibility; and>
16-27 <(6) other factors considered relevant by the board.>
17-1 <(b) A physician licensed by the board shall comply with the
17-2 standards adopted by the board as provided by this section.>
17-3 <(c)(1) The physician assistants advisory committee is
17-4 established.>
17-5 <(2) The physician assistants advisory committee
17-6 consists of not more than six physician assistants appointed by the
17-7 board. A member of the advisory committee serves for a term of one
17-8 year expiring on May 1 of each year.>
17-9 <(3) The advisory committee shall advise the board on
17-10 matters relating to physician assistants. In order to assure that
17-11 the advisory committee is able to exercise properly its advisory
17-12 powers, the board shall provide the advisory committee with timely
17-13 notice of all board meetings on matters relating to physician
17-14 assistants and a copy of the minutes of all board meetings on
17-15 matters relating to physician assistants. In addition, the board
17-16 may not adopt any rule relating to the practice of physician
17-17 assistants that is not an emergency matter unless the proposed rule
17-18 has been submitted to the advisory committee for review and comment
17-19 at least 30 days prior to the adoption of the rule.>
17-20 <(d) The board shall adopt rules establishing:>
17-21 <(1) any specialized education and training, including
17-22 pharmacology, a physician assistant must have to carry out a
17-23 prescription drug order pursuant to Subdivision (5), Subsection
17-24 (d), Section 3.06, of this Act; and>
17-25 <(2) a system for assigning an identification number
17-26 to a physician assistant who provides the board with evidence of
17-27 completing the required specialized education and training.>
18-1 SECTION 27. CONFORMING AMENDMENT. Section 110.001(3), Civil
18-2 Practice and Remedies Code, is amended to read as follows:
18-3 (3) "Health care professional" means:
18-4 (A) a person who is licensed to practice
18-5 medicine under the Medical Practice Act (Article 4495b, Vernon's
18-6 Texas Civil Statutes);
18-7 (B) a person registered by the Board of Nurse
18-8 Examiners as an advanced nurse practitioner or a certified nurse
18-9 midwife; or
18-10 (C) a person licensed <recognized> by the
18-11 Physician Assistant Advisory Council under the Texas State Board of
18-12 Medical Examiners as a physician assistant.
18-13 SECTION 28. TRANSITION. (a) A person is not required to
18-14 obtain a license under this Act until September 1, 1994.
18-15 (b) The council shall adopt rules under this Act not later
18-16 than January 1, 1994.
18-17 (c) In making the initial appointments to the council, the
18-18 governor shall designate three members for terms expiring February
18-19 1, 1995, three members for terms expiring February 1, 1997, and
18-20 three members for terms expiring February 1, 1999.
18-21 (d) The physician assistants advisory committee created
18-22 under Section 5.02(c), Medical Practice Act (Article 4495b,
18-23 Vernon's Texas Civil Statutes), is abolished on the effective date
18-24 of this Act.
18-25 SECTION 29. EFFECTIVE DATE. This Act takes effect September
18-26 1, 1993, except that Sections 3 and 20 take effect September 1,
18-27 1994.
19-1 SECTION 30. EMERGENCY. The importance of this legislation
19-2 and the crowded condition of the calendars in both houses create an
19-3 emergency and an imperative public necessity that the
19-4 constitutional rule requiring bills to be read on three several
19-5 days in each house be suspended, and this rule is hereby suspended.