Rep. Norm Thurston — Voting Record

Bill

Number

H.B. 341 (2020GS)

Sponsor

Rep. Barlow, S.

Final action

Governor Signed 3/24/2020

Outcome

Became law — signed by Gov. Gary R. Herbert

Summary

What it does

• This bill:
• changes the areas where associate physicians can practice; and
• changes the time period for which associate physicians can be licensed.

Every vote on this bill

Bill text

ASSOCIATE PHYSICIAN LICENSE AMENDMENTS
GENERAL SESSION
STATE OF UTAH
Chief Sponsor: Stewart E. Barlow
Senate Sponsor: 
David G. Buxton
LONG TITLE
General Description:
This bill amends the licensing requirements for associate physicians.
Highlighted Provisions:
This bill:
▸ changes the areas where associate physicians can practice; and
▸ changes the time period for which associate physicians can be licensed.
Money Appropriated in this Bill:
None
Other Special Clauses:
None
Utah Code Sections Affected:
AMENDS:
58-67-302.8
, as last amended by Laws of Utah 2018, Chapter 318
58-67-303
, as last amended by Laws of Utah 2019, Chapter 447
58-67-807
, as enacted by Laws of Utah 2017, Chapter 299
58-68-302.5
, as last amended by Laws of Utah 2018, Chapter 318
58-68-303
, as last amended by Laws of Utah 2019, Chapter 447
58-68-807
, as enacted by Laws of Utah 2017, Chapter 299
Be it enacted by the Legislature of the state of Utah:
Section 1. Section 
58-67-302.8
 is amended to read:
58-67-302.8.
Restricted licensing of an associate physician.
(1) An individual may apply for a restricted license as an associate physician if the
individual:
(a) meets the requirements described in Subsections 
58-67-302
(1)(a) through (d),
(1)(e)(i), and (1)(h) through (k);
(b) successfully completes Step 1 and Step 2 of the United States Medical Licensing
Examination or the equivalent steps of another board-approved medical licensing examination:
(i) within three years after the day on which the applicant graduates from a program
described in Subsection 
58-67-302
(1)(e)(i); and
(ii) within two years before applying for a restricted license as an associate physician;
and
(c) is not currently enrolled in and has not completed a residency program.
(2) Before a licensed associate physician may engage in the practice of medicine as
described in Subsection (3), the licensed associate physician shall:
(a) enter into a collaborative practice arrangement described in Section 
58-67-807
within six months after the associate physician's initial licensure; and
(b) receive division approval of the collaborative practice arrangement.
(3) An associate physician's scope of practice is limited to primary care services [
to
medically underserved populations or in medically underserved areas within the state
].
Section 2. Section 
58-67-303
 is amended to read:
58-67-303.
Term of license -- Expiration -- Renewal.
(1) (a) Except as provided in Section 
58-67-302.7
, the division shall issue each license
under this chapter in accordance with a two-year renewal cycle established by division rule.
(b) The division may by rule extend or shorten a renewal period by as much as one year
to stagger the renewal cycles the division administers.
(2) At the time of renewal, the licensee shall:
(a) view a suicide prevention video described in Section 
58-1-601
 and submit proof in
the form required by the division;
(b) show compliance with continuing education renewal requirements; and
(c) show compliance with the requirement for designation of a contact person and
alternate contact person for access to medical records and notice to patients as required by
Subsections 
58-67-304
(1)(b) and (c).
(3) Each license issued under this chapter expires on the expiration date shown on the
license unless renewed in accordance with Section 
58-1-308
.
(4) An individual may not be licensed as an associate physician for more than a total of
[
four
] 
six
 years.
Section 3. Section 
58-67-807
 is amended to read:
58-67-807.
Collaborative practice arrangement.
(1) (a) The division, in consultation with the board, shall make rules in accordance
with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, regarding the approval of a
collaborative practice arrangement.
(b) The division shall require a collaborative practice arrangement to:
(i) limit the associate physician to providing primary care services [
to medically
underserved populations or in medically underserved areas within the state
];
(ii) be consistent with the skill, training, and competence of the associate physician;
(iii) specify jointly agreed-upon protocols, or standing orders for the delivery of health
care services by the associate physician;
(iv) provide complete names, home and business addresses, zip codes, and telephone
numbers of the collaborating physician and the associate physician;
(v) list all other offices or locations besides those listed in Subsection (1)(b)(iv) where
the collaborating physician authorizes the associate physician to prescribe;
(vi) require at every office where the associate physician is authorized to prescribe in
collaboration with a physician a prominently displayed disclosure statement informing patients
that patients may be seen by an associate physician and have the right to see the collaborating
physician;
(vii) specify all specialty or board certifications of the collaborating physician and all
certifications of the associate physician;
(viii) specify the manner of collaboration between the collaborating physician and the
associate physician, including how the collaborating physician and the associate physician
shall:
(A) engage in collaborative practice consistent with each professional's skill, training,
education, and competence;
(B) maintain geographic proximity, except as provided in Subsection (1)(d); and
(C) provide oversight of the associate physician during the absence, incapacity,
infirmity, or emergency of the collaborating physician;
(ix) describe the associate physician's controlled substance prescriptive authority in
collaboration with the collaborating physician, including:
(A) a list of the controlled substances the collaborating physician authorizes the
associate physician to prescribe; and
(B) documentation that the authorization to prescribe the controlled substances is
consistent with the education, knowledge, skill, and competence of the associate physician and
the collaborating physician;
(x) list all other written practice arrangements of the collaborating physician and the
associate physician;
(xi) specify the duration of the written practice arrangement between the collaborating
physician and the associate physician; and
(xii) describe the time and manner of the collaborating physician's review of the
associate physician's delivery of health care services, including provisions that the
collaborating physician, or another physician designated in the collaborative practice
arrangement, shall review every 14 days:
(A) a minimum of 10% of the charts documenting the associate physician's delivery of
health care services; and
(B) a minimum of 20% of the charts in which the associate physician prescribes a
controlled substance, which may be counted in the number of charts to be reviewed under
Subsection (1)(b)(xii)(A).
(c) An associate physician and the collaborating physician may modify a collaborative
practice arrangement, but the changes to the collaborative practice arrangement are not binding
unless:
(i) the associate physician notifies the division within 10 days after the day on which
the changes are made; and
(ii) the division approves the changes.
(d) If the collaborative practice arrangement provides for an associate physician to
practice in a medically underserved area:
(i) the collaborating physician shall document the completion of at least a two-month
period of time during which the associate physician shall practice with the collaborating
physician continuously present before practicing in a setting where the collaborating physician
is not continuously present; and
(ii) the collaborating physician shall document the completion of at least 120 hours in a
four-month period by the associate physician during which the associate physician shall
practice with the collaborating physician on-site before prescribing a controlled substance
when the collaborating physician is not on-site.
(2) An associate physician:
(a) shall clearly identify himself or herself as an associate physician;
(b) is permitted to use the title "doctor" or "Dr."; and
(c) if authorized under a collaborative practice arrangement to prescribe Schedule III
through V controlled substances, shall register with the United States Drug Enforcement
Administration as part of the drug enforcement administration's mid-level practitioner registry.
(3) (a) A physician or surgeon licensed and in good standing under Section 
58-67-302
may enter into a collaborative practice arrangement with an associate physician licensed under
Section 
58-67-302.8
.
(b) A physician or surgeon may not enter into a collaborative practice arrangement
with more than three full-time equivalent associate physicians.
(c) (i) No contract or other agreement shall:
(A) require a physician to act as a collaborating physician for an associate physician
against the physician's will;
(B) deny a collaborating physician the right to refuse to act as a collaborating
physician, without penalty, for a particular associate physician; or
(C) limit the collaborating physician's ultimate authority over any protocols or standing
orders or in the delegation of the physician's authority to any associate physician.
(ii) Subsection (3)(c)(i)(C) does not authorize a physician, in implementing protocols,
standing orders, or delegation, to violate a hospital's established applicable standards for safe
medical practice.
(d) A collaborating physician is responsible at all times for the oversight of the
activities of, and accepts responsibility for, the primary care services rendered by the associate
physician.
(4) The division shall makes rules, in consultation with the board, the deans of medical
schools in the state, and primary care residency program directors in the state, and in
accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, establishing
educational methods and programs that:
(a) an associate physician shall complete throughout the duration of the collaborative
practice arrangement;
(b) shall facilitate the advancement of the associate physician's medical knowledge and
capabilities; and
(c) may lead to credit toward a future residency program.
Section 4. Section 
58-68-302.5
 is amended to read:
58-68-302.5.
Restricted licensing of an associate physician.
(1) An individual may apply for a restricted license as an associate physician if the
individual:
(a) meets the requirements described in Subsections 
58-68-302
(1)(a) through (d),
(1)(e)(i), and (1)(h) through (k);
(b) successfully completes Step 1 and Step 2 of the United States Medical Licensing
Examination or the equivalent steps of another board-approved medical licensing examination:
(i) within three years after the day on which the applicant graduates from a program
described in Subsection 
58-68-302
(1)(e)(i); and
(ii) within two years before applying for a restricted license as an associate physician;
and
(c) is not currently enrolled in and has not completed a residency program.
(2) Before a licensed associate physician may engage in the practice of medicine as
described in Subsection (3), the licensed associate physician shall:
(a) enter into a collaborative practice arrangement described in Section 
58-68-807
within six months after the associate physician's initial licensure; and
(b) receive division approval of the collaborative practice arrangement.
(3) An associate physician's scope of practice is limited to primary care services [
to
medically underserved populations or in medically underserved areas within the state
].
Section 5. Section 
58-68-303
 is amended to read:
58-68-303.
Term of license -- Expiration -- Renewal.
(1) (a) The division shall issue each license under this chapter in accordance with a
two-year renewal cycle established by division rule.
(b) The division may by rule extend or shorten a renewal period by as much as one year
to stagger the renewal cycles the division administers.
(2) At the time of renewal, the licensee shall:
(a) view a suicide prevention video described in Section 
58-1-601
 and submit proof in
the form required by the division;
(b) show compliance with continuing education renewal requirements; and
(c) show compliance with the requirement for designation of a contact person and
alternate contact person for access to medical records and notice to patients as required by
Subsections 
58-68-304
(1)(b) and (c).
(3) Each license issued under this chapter expires on the expiration date shown on the
license unless renewed in accordance with Section 
58-1-308
.
(4) An individual may not be licensed as an associate physician for more than a total of
[
four
] 
six
 years.
Section 6. Section 
58-68-807
 is amended to read:
58-68-807.
Collaborative practice arrangement.
(1) (a) The division, in consultation with the board, shall make rules in accordance
with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, regarding the approval of a
collaborative practice arrangement.
(b) The division shall require a collaborative practice arrangement to:
(i) limit the associate physician to providing primary care services [
to medically
underserved populations or in medically underserved areas within the state
];
(ii) be consistent with the skill, training, and competence of the associate physician;
(iii) specify jointly agreed-upon protocols, or standing orders for the delivery of health
care services by the associate physician;
(iv) provide complete names, home and business addresses, zip codes, and telephone
numbers of the collaborating physician and the associate physician;
(v) list all other offices or locations besides those listed in Subsection (1)(b)(iv) where
the collaborating physician authorizes the associate physician to prescribe;
(vi) require at every office where the associate physician is authorized to prescribe in
collaboration with a physician a prominently displayed disclosure statement informing patients
that patients may be seen by an associate physician and have the right to see the collaborating
physician;
(vii) specify all specialty or board certifications of the collaborating physician and all
certifications of the associate physician;
(viii) specify the manner of collaboration between the collaborating physician and the
associate physician, including how the collaborating physician and the associate physician
shall:
(A) engage in collaborative practice consistent with each professional's skill, training,
education, and competence;
(B) maintain geographic proximity, except as provided in Subsection (1)(d); and
(C) provide oversight of the associate physician during the absence, incapacity,
infirmity, or emergency of the collaborating physician;
(ix) describe the associate physician's controlled substance prescriptive authority in
collaboration with the collaborating physician, including:
(A) a list of the controlled substances the collaborating physician authorizes the
associate physician to prescribe; and
(B) documentation that the authorization to prescribe the controlled substances is
consistent with the education, knowledge, skill, and competence of the associate physician and
the collaborating physician;
(x) list all other written practice arrangements of the collaborating physician and the
associate physician;
(xi) specify the duration of the written practice arrangement between the collaborating
physician and the associate physician; and
(xii) describe the time and manner of the collaborating physician's review of the
associate physician's delivery of health care services, including provisions that the
collaborating physician, or another physician designated in the collaborative practice
arrangement, shall review every 14 days:
(A) a minimum of 10% of the charts documenting the associate physician's delivery of
health care services; and
(B) a minimum of 20% of the charts in which the associate physician prescribes a
controlled substance, which may be counted in the number of charts to be reviewed under
Subsection (1)(b)(xii)(A).
(c) An associate physician and the collaborating physician may modify a collaborative
practice arrangement, but the changes to the collaborative practice arrangement are not binding
unless:
(i) the associate physician notifies the division within 10 days after the day on which
the changes are made; and
(ii) the division approves the changes.
(d) If the collaborative practice arrangement provides for an associate physician to
practice in a medically underserved area:
(i) the collaborating physician shall document the completion of at least a two-month
period of time during which the associate physician shall practice with the collaborating
physician continuously present before practicing in a setting where the collaborating physician
is not continuously present; and
(ii) the collaborating physician shall document the completion of at least 120 hours in a
four-month period by the associate physician during which the associate physician shall
practice with the collaborating physician on-site before prescribing a controlled substance
when the collaborating physician is not on-site.
(2) An associate physician:
(a) shall clearly identify himself or herself as an associate physician;
(b) is permitted to use the title "doctor" or "Dr."; and
(c) if authorized under a collaborative practice arrangement to prescribe Schedule III
through V controlled substances, shall register with the United States Drug Enforcement
Administration as part of the drug enforcement administration's mid-level practitioner registry.
(3) (a) A physician or surgeon licensed and in good standing under Section 
58-68-302
may enter into a collaborative practice arrangement with an associate physician licensed under
Section 
58-68-302.5
.
(b) A physician or surgeon may not enter into a collaborative practice arrangement
with more than three full-time equivalent associate physicians.
(c) (i) No contract or other agreement shall:
(A) require a physician to act as a collaborating physician for an associate physician
against the physician's will;
(B) deny a collaborating physician the right to refuse to act as a collaborating
physician, without penalty, for a particular associate physician; or
(C) limit the collaborating physician's ultimate authority over any protocols or standing
orders or in the delegation of the physician's authority to any associate physician.
(ii) Subsection (3)(c)(i)(C) does not authorize a physician, in implementing such
protocols, standing orders, or delegation, to violate a hospital's established applicable standards
for safe medical practice.
(d) A collaborating physician is responsible at all times for the oversight of the
activities of, and accepts responsibility for, the primary care services rendered by the associate
physician.
(4) The division shall makes rules, in consultation with the board, the deans of medical
schools in the state, and primary care residency program directors in the state, and in
accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, establishing
educational methods and programs that:
(a) an associate physician shall complete throughout the duration of the collaborative
practice arrangement;
(b) shall facilitate the advancement of the associate physician's medical knowledge and
capabilities; and
(c) may lead to credit toward a future residency program.