Rep. Norm Thurston — Voting Record

Bill

Number

S.B. 28 Second Substitute (2021GS)

Sponsor

Sen. Bramble, C.

Final action

Governor Signed 3/17/2021

Outcome

Became law — signed by Gov. Spencer J. Cox

Summary

What it does

• This bill:
• defines terms;
• amends the Mental Health Professional Practice Act to allow a physician assistant who specializes in mental health to engage in the practice of mental health therapy;
• describes the qualifications for a physician assistant to specialize in mental health care;
• defines the additional scope of practice for a physician assistant specializing in mental health care; and
• makes technical and corresponding changes.

Every vote on this bill

Bill text

PHYSICIAN ASSISTANT MENTAL HEALTH PRACTICE
AMENDMENTS
GENERAL SESSION
STATE OF UTAH
Chief Sponsor: Curtis S. Bramble
House Sponsor: 
James A. Dunnigan
LONG TITLE
General Description:
This bill allows a physician assistant to specialize in mental health care and defines the
requirements and scope of practice for this specialization.
Highlighted Provisions:
This bill:
▸ defines terms;
▸ amends the Mental Health Professional Practice Act to allow a physician assistant
who specializes in mental health to engage in the practice of mental health therapy;
▸ describes the qualifications for a physician assistant to specialize in mental health
care;
▸ defines the additional scope of practice for a physician assistant specializing in
mental health care; and
▸ makes technical and corresponding changes.
Money Appropriated in this Bill:
None
Other Special Clauses:
This bill provides a coordination clause.
Utah Code Sections Affected:
AMENDS:
58-60-102
, as last amended by Laws of Utah 2013, Chapters 16 and 123
58-60-103
, as last amended by Laws of Utah 2015, Chapter 258
58-60-107
, as last amended by Laws of Utah 2013, Chapter 16
58-70a-102
, as last amended by Laws of Utah 2017, Chapter 309
58-70a-201
, as last amended by Laws of Utah 2010, Chapter 37
ENACTS:
58-70a-501.1
, Utah Code Annotated 1953
58-70a-501.2
, Utah Code Annotated 1953
Utah Code Sections Affected by Coordination Clause:
 58-70a-307
, Utah Code Annotated 1953
58-70a-501.1
, Utah Code Annotated 1953
Be it enacted by the Legislature of the state of Utah:
Section 1. Section 
58-60-102
 is amended to read:
58-60-102.
Definitions.
In addition to the definitions in Section 
58-1-102
, as used in this chapter:
(1) "Client" or "patient" means an individual who consults or is examined or
interviewed by an individual licensed under this chapter who is acting in the individual's
professional capacity.
(2) "Confidential communication" means information obtained by an individual
licensed under this chapter, including information obtained by the individual's examination of
the client or patient, which is:
(a) (i) transmitted between the client or patient and an individual licensed under this
chapter in the course of that relationship; or
(ii) transmitted among the client or patient, an individual licensed under this chapter,
and individuals who are participating in the diagnosis or treatment under the direction of an
individual licensed under this chapter, including members of the client's or patient's family; and
(b) made in confidence, for the diagnosis or treatment of the client or patient by the
individual licensed under this chapter, and by a means not intended to be disclosed to third
persons other than those individuals:
(i) present to further the interest of the client or patient in the consultation,
examination, or interview;
(ii) reasonably necessary for the transmission of the communications; or
(iii) participating in the diagnosis and treatment of the client or patient under the
direction of the mental health therapist.
(3) "Hypnosis" means, when referring to individuals exempted from licensure under
this chapter, a process by which an individual induces or assists another individual into a
hypnotic state without the use of drugs or other substances and for the purpose of increasing
motivation or to assist the individual to alter lifestyles or habits.
(4) "Individual" means a natural person.
(5) "Mental health therapist" means an individual who is practicing within the scope of
practice defined in the individual's respective licensing act and is licensed under this title as:
(a) a physician and surgeon, or osteopathic physician engaged in the practice of mental
health therapy;
(b) an advanced practice registered nurse, specializing in psychiatric mental health
nursing;
(c) an advanced practice registered nurse intern, specializing in psychiatric mental
health nursing;
(d) a psychologist qualified to engage in the practice of mental health therapy;
(e) a certified psychology resident qualifying to engage in the practice of mental health
therapy;
(f) a physician assistant specializing in mental health care under Section 
58-70a-501.1
;
[
(f)
] 
(g)
 a clinical social worker;
[
(g)
] 
(h)
 a certified social worker;
[
(h)
] 
(i)
 a marriage and family therapist;
[
(i)
] 
(j)
 an associate marriage and family therapist;
[
(j)
] 
(k)
 a clinical mental health counselor; or
[
(k)
] 
(l)
 an associate clinical mental health counselor.
(6) "Mental illness" means a mental or emotional condition defined in an approved
diagnostic and statistical manual for mental disorders generally recognized in the professions of
mental health therapy listed under Subsection (5).
(7) "Practice of mental health therapy" means treatment or prevention of mental illness,
whether in person or remotely, including:
(a) conducting a professional evaluation of an individual's condition of mental health,
mental illness, or emotional disorder consistent with standards generally recognized in the
professions of mental health therapy listed under Subsection (5);
(b) establishing a diagnosis in accordance with established written standards generally
recognized in the professions of mental health therapy listed under Subsection (5);
(c) prescribing a plan for the prevention or treatment of a condition of mental illness or
emotional disorder; and
(d) engaging in the conduct of professional intervention, including psychotherapy by
the application of established methods and procedures generally recognized in the professions
of mental health therapy listed under Subsection (5).
(8) "Remotely" means communicating via Internet, telephone, or other electronic
means that facilitate real-time audio or visual interaction between individuals when they are not
physically present in the same room at the same time.
(9) "Unlawful conduct" is as defined in Sections 
58-1-501
 and 
58-60-109
.
(10) "Unprofessional conduct" is as defined in Sections 
58-1-501
 and 
58-60-110
, and
may be further defined by division rule.
Section 2. Section 
58-60-103
 is amended to read:
58-60-103.
Licensure required.
(1) 
(a)
 An individual shall be licensed under
:
(i)
 this chapter;
(ii)
 Chapter 67, Utah Medical Practice Act;
(iii)
 Chapter 68, Utah Osteopathic Medical Practice Act;
(iv)
 Chapter 31b, Nurse Practice Act;
(v)
 Chapter 61, Psychologist Licensing Act;
(vi) Chapter 70a, Utah Physician Assistant Act;
 or
(vii)
 exempted from licensure under this chapter [
in order to:
]
.
(b) Only an individual described in Subsection (1)(a) may:
[
(a)
] 
(i)
 engage in, or represent that the individual will engage in, the practice of mental
health therapy, clinical social work, certified social work, marriage and family therapy, or
clinical mental health counseling; or
[
(b)
] 
(ii)
 practice as, or represent that the individual is, a mental health therapist,
clinical social worker, certified social worker, marriage and family therapist, clinical mental
health counselor, psychiatrist, psychologist, registered psychiatric mental health nurse
specialist, certified psychology resident, associate marriage and family therapist, or associate
clinical mental health counselor.
(2) An individual shall be licensed under this chapter or exempted from licensure under
this chapter in order to:
(a) engage in, or represent that the individual is engaged in, practice as a social service
worker; or
(b) represent that the individual is, or use the title of, a social service worker.
(3) An individual shall be licensed under this chapter or exempted from licensure under
this chapter in order to:
(a) engage in, or represent that the individual is engaged in, practice as a substance use
disorder counselor; or
(b) represent that the individual is, or use the title of, a substance use disorder
counselor.
(4) Notwithstanding the provisions of Subsection 
58-1-307
(1)(c), an individual shall be
certified under this chapter, or otherwise exempted from licensure under this chapter, in order
to engage in an internship or residency program of supervised clinical training necessary to
meet the requirements for licensure as:
(a) a marriage and family therapist under Part 3, Marriage and Family Therapist
Licensing Act; or
(b) a clinical mental health counselor under Part 4, Clinical Mental Health Counselor
Licensing Act.
Section 3. Section 
58-60-107
 is amended to read:
58-60-107.
Exemptions from licensure.
(1) Except as modified in Section 
58-60-103
, the exemptions from licensure in Section
58-1-307
 apply to this chapter.
(2) In addition to the exemptions from licensure in Section 
58-1-307
, the following
may engage in acts included within the definition of practice as a mental health therapist,
subject to the stated circumstances and limitations, without being licensed under this chapter:
(a) the following when practicing within the scope of the license held:
(i) a physician and surgeon or osteopathic physician and surgeon licensed under
Chapter 67, Utah Medical Practice Act, or Chapter 68, Utah Osteopathic Medical Practice Act;
(ii) an advanced practice registered nurse, specializing in psychiatric mental health
nursing, licensed under Chapter 31b, Nurse Practice Act; [
and
]
(iii) a psychologist licensed under Chapter 61, Psychologist Licensing Act; 
and
(iv) a physician assistant licensed under Chapter 70a, Utah Physician Assistant Act,
and specializing in mental health care under Section 
58-70a-501.1
;
(b) a recognized member of the clergy while functioning in a ministerial capacity as
long as the member of the clergy does not represent that the member of the clergy is, or use the
title of, a license classification in Subsection 
58-60-102
(5);
(c) an individual who is offering expert testimony in a proceeding before a court,
administrative hearing, deposition upon the order of a court or other body having power to
order the deposition, or a proceeding before a master, referee, or alternative dispute resolution
provider;
(d) an individual engaged in performing hypnosis who is not licensed under this title in
a profession which includes hypnosis in its scope of practice, and who:
(i) (A) induces a hypnotic state in a client for the purpose of increasing motivation or
altering lifestyles or habits, such as eating or smoking, through hypnosis;
(B) consults with a client to determine current motivation and behavior patterns;
(C) prepares the client to enter hypnotic states by explaining how hypnosis works and
what the client will experience;
(D) tests clients to determine degrees of suggestibility;
(E) applies hypnotic techniques based on interpretation of consultation results and
analysis of client's motivation and behavior patterns; and
(F) trains clients in self-hypnosis conditioning;
(ii) may not:
(A) engage in the practice of mental health therapy;
(B) use the title of a license classification in Subsection 
58-60-102
(5); or
(C) use hypnosis with or treat a medical, psychological, or dental condition defined in
generally recognized diagnostic and statistical manuals of medical, psychological, or dental
disorders;
(e) an individual's exemption from licensure under Subsection 
58-1-307
(1)(b)
terminates when the student's training is no longer supervised by qualified faculty or staff and
the activities are no longer a defined part of the degree program;
(f) an individual holding an earned doctoral degree or master's degree in social work,
marriage and family therapy, or clinical mental health counseling, who is employed by an
accredited institution of higher education and who conducts research and teaches in that
individual's professional field, but only if the individual does not engage in providing or
supervising professional services regulated under this chapter to individuals or groups
regardless of whether there is compensation for the services;
(g) an individual in an on-the-job training program approved by the division while
under the supervision of qualified persons;
(h) an individual providing general education in the subjects of alcohol, drug use, or
substance use disorders, including prevention;
(i) an individual providing advice or counsel to another individual in a setting of their
association as friends or relatives and in a nonprofessional and noncommercial relationship, if
there is no compensation paid for the advice or counsel; and
(j) an individual who is licensed, in good standing, to practice mental health therapy or
substance use disorder counseling in a state or territory of the United States outside of Utah
may provide short term transitional mental health therapy remotely or short term transitional
substance use disorder counseling remotely to a client in Utah only if:
(i) the individual is present in the state or territory where the individual is licensed to
practice mental health therapy or substance use disorder counseling;
(ii) the client relocates to Utah;
(iii) the client is a client of the individual immediately before the client relocates to
Utah;
(iv) the individual provides the short term transitional mental health therapy or short
term transitional substance use disorder counseling remotely to the client only during the 45
day period beginning on the day on which the client relocates to Utah;
(v) within 10 days after the day on which the client relocates to Utah, the individual
provides written notice to the division of the individual's intent to provide short term
transitional mental health therapy or short term transitional substance use disorder counseling
remotely to the client; and
(vi) the individual does not engage in unlawful conduct or unprofessional conduct.
Section 4. Section 
58-70a-102
 is amended to read:
58-70a-102.
Definitions.
In addition to the definitions in Section 
58-1-102
, as used in this chapter:
(1) "Board" means the Physician Assistant Licensing Board created in Section
58-70a-201
.
(2) (a) "Delegation of services agreement" means written criteria jointly developed by a
physician assistant's supervising physician and substitute supervising physicians and the
physician assistant, that permits a physician assistant, working under the direction or review of
the supervising physician, to assist in the management of common illnesses and injuries.
(b) The agreement defines the working relationship and delegation of duties between
the supervising physician and the physician assistant as specified by division rule and shall
include:
(i) the prescribing of controlled substances;
(ii) the degree and means of supervision;
(iii) the frequency and mechanism of quality review, including the mechanism for
review of patient data and documentation of the review, as determined by the supervising
physician and the physician assistant;
(iv) procedures addressing situations outside the scope of practice of the physician
assistant; and
(v) procedures for providing backup for the physician assistant in emergency situations.
(3) "Direct supervision" means the supervising physician is:
(a) physically present at the point of patient treatment on site where the physician
assistant he is supervising is practicing; and
(b) immediately available for consultation with the physician assistant.
(4) "Mental health therapist" means the same as that term is defined in Section
58-60-102
.
[
(4)
] 
(5)
 "Practice as a physician assistant" means:
(a) the professional activities and conduct of a physician assistant, also known as a PA,
in diagnosing, treating, advising, or prescribing for any human disease, ailment, injury,
infirmity, deformity, pain, or other condition, dependent upon and under the supervision of a
supervising physician or substitute supervising physician in accordance with a delegation of
services agreement; and
(b) the physician assistant acts as the agent of the supervising physician or substitute
supervising physician when acting in accordance with a delegation of services agreement.
(6) "Practice of mental health therapy" means the same as that term is defined in
Section 
58-60-102
.
[
(5)
] 
(7)
 "Substitute supervising physician" means an individual who meets the
requirements of a supervising physician under this chapter and acts as the supervising physician
in the absence of the supervising physician.
[
(6)
] 
(8)
 "Supervising physician" means an individual who:
(a) is currently licensed to practice under Title 58, Chapter 67, Utah Medical Practice
Act, or Title 58, Chapter 68, Utah Osteopathic Medical Practice Act;
(b) acts as the primary supervisor of a physician assistant and takes responsibility for
the professional practice and conduct of a physician assistant in accordance with this chapter;
and
(c) is not an employee of the physician assistant whom the individual supervises.
[
(7)
] 
(9)
 "Supervision" means the supervising physician is available for consultation
with the physician assistant, either personally or by other means permitting direct verbal
communication between the physician and the physician assistant.
[
(8)
] 
(10)
 "Unlawful conduct" 
means the same as that term
 is [
as
] defined in Sections
58-1-501
 and 
58-70a-502
.
[
(9)
] 
(11)
 "Unprofessional conduct" [
is
] 
means "unprofessional conduct":
(a)
 as defined in Sections 
58-1-501
 and 
58-70a-503
;
 and [
as may be further defined by
rule.
]
(b) as further defined by the division by rule.
Section 5. Section 
58-70a-201
 is amended to read:
58-70a-201.
Board.
(1) There is created the Physician Assistant Licensing Board, which consists of seven
members:
(a) three licensed physicians[
, at least two of whom are individuals who are supervising
or who have supervised a physician assistant
]
, including at least one board certified
psychiatrist, who currently work or have previously worked collaboratively with a physician
assistant
;
(b) three physician assistants, one of whom is involved in the administration of an
approved physician assistant education program within the state; and
(c) one person from the general public.
(2) The board shall be appointed and serve in accordance with Section 
58-1-201
.
(3) The duties and responsibilities of the board are in accordance with Sections
58-1-202
 and 
58-1-203
. In addition, the board shall designate one of its members on a
permanent or rotating basis to:
(a) assist the division in reviewing complaints concerning the unlawful or
unprofessional conduct of a licensee; and
(b) advise the division in its investigation of these complaints.
(4) A board member who has, under Subsection (3), reviewed a complaint or advised
in its investigation may be disqualified from participating with the board when the board serves
as a presiding officer in an adjudicative proceeding concerning the complaint. The board
member may be disqualified:
(a) on the member's own motion, due to actual or perceived bias or lack of objectivity;
or
(b) upon challenge for cause raised on the record by any party to the adjudicative
proceeding.
Section 6. Section 
58-70a-501.1
 is enacted to read:
 58-70a-501.1.
Qualifications for a physician assistant specializing in mental health
care -- Rulemaking.
(1) A physician assistant specializing in mental health care under this section shall:
(a) hold a valid license as a physician assistant under this chapter;
(b) obtain and maintain a Certification of Added Qualification in psychiatry issued by
the National Commission on Certification of Physician Assistants;
(c) complete:
(i) an accredited doctorate level academic program for physician assistants approved by
the division in collaboration with the board;
(ii) a post-graduate certificate program for physician assistants to practice within
psychiatric and mental health care that is approved by the division in collaboration with the
board; or
(iii) a post-graduate residency in psychiatry and additional clinical practice or
coursework in accordance with requirements approved by the division in collaboration with the
board; and
(d) complete the clinical practice requirement described in Subsection (4).
(2) The division, in collaboration with the board, may approve a program under
Subsections (1)(c)(i) and (ii), if the program:
(a) is an accredited doctoral level or post-graduate academic program;
(b) includes at least 1,600 hours of accredited instructional hours that results in:
(i) a doctorate degree or equivalent; or
(ii) a graduate level certification in psychiatric mental health; and
(c) provides graduate level instruction in:
(i) at least 2 credit hours or equivalent of neuroscience;
(ii) health care law and ethics;
(iii) health care delivery;
(iv) evidence-based mental health medicine;
(v) evidence-based mental health research;
(vi) at least 3 credit hours or equivalent of psychotherapy;
(vii) psychiatric assessment;
(viii) crisis intervention;
(ix) group and family therapy;
(x) suicide risk assessment;
(xi) violence risk assessment;
(xii) at least 3 credit hours or equivalent of psychopharmacology;
(xiii) a comprehensive review of mental disorders as characterized by the current
Diagnostic and Statistical Manual of Mental Disorders, including diagnostic criteria and
prevalence; and
(xiv) medical and therapeutic management of each condition across the lifespan in
diverse populations and in a variety of clinical settings.
(3) The division, in collaboration with the board, may:
(a) approve and accept the completion of a post-graduate residency in psychiatry under
Subsection (1)(c)(iii) if the residency includes clinical and academic training that is
substantially equivalent to the training described in Subsections (2)(b) and (c); and
(b) require the completion of additional coursework or clinical hours for an individual
who meets the training requirement under Subsection (1)(c) through a post-graduate residency
in psychiatry.
(4) (a) A physician assistant specializing in mental health care under this section shall
complete 10,000 hours of clinical practice in mental health.
(b) The clinical practice hours described in Subsection (4)(a) shall be completed after
the individual passes the Physician Assistant National Certifying Exam administered by the
National Commission on Certification of Physician Assistants.
(c) Up to 1,000 hours of clinical practice under Subsection (4)(a) may be completed as
part of an approved education program in mental health if the clinical practice hours meet the
requirements described in Subsection (4)(d).
(d) (i) At least the first 4,000 hours of the clinical practice hours described in
Subsection (4)(a) shall be completed under the supervision of a psychiatrist.
(ii) At least 2,000 hours of the clinical practice hours described in Subsection (4)(a)
shall be completed in psychotherapy under the supervision of a mental health therapist or a
psychiatrist who has been trained in and has at least two years of practice experience in
psychotherapy.
(iii) The remaining clinical practice hours required under Subsection (4)(a) and not
received under Subsections (4)(d)(i) and (ii) shall be completed in collaboration with a
psychiatrist.
(5) The division, in collaboration with the board, shall establish continuing education
requirements for a physician assistant specializing in mental health care under this section.
Section 7. Section 
58-70a-501.2
 is enacted to read:
 58-70a-501.2.
Scope of practice for a physician assistant specializing in mental
health care.
(1) (a) A physician assistant specializing in mental health care under Section
58-70a-501.1
 may engage in the practice of mental health therapy consistent with the physician
assistant's education, experience, and competence.
(b) Section 
58-70a-501
 applies to a physician assistant specializing in mental health
care in addition to this section.
(2) A physician assistant specializing in mental health care is responsible for meeting
the local standards of care in the provision of services, including mental health therapy and
psychopharmacology.
(3) (a) Except as provided in Subsection (3)(b), a physician assistant specializing in
mental health care may administer a behavioral health screening instrument.
(b) A physician assistant specializing in mental health care may not perform a
psychological or neuropsychological assessment or evaluation, including:
(i) an intellectual assessment;
(ii) a forensic assessment or evaluation; and
(iii) administration of a psychological or neuropsychological test or instrument that
requires qualification level B or qualification level C under the Standards for Educational and
Psychological Testing approved as policy by the American Psychological Association.
(4) (a) A physician assistant may not administer neurostimulation or neuromodulation.
(b) Subsection (4)(a) does not apply to neurostimulation or neuromodulation
administered by a physician assistant:
(i) in a health care facility; and
(ii) under supervision of a physician whose usual scope of practice includes
neurostimulation or neuromodulation.
(5) As a condition of probation or reinstatement of a license, the division may require
that, for a specified duration, a physician assistant specializing in mental health care 
collaborate with or practice under the supervision of a physician who is board certified in
psychiatry.
(6) A physician assistant who is in the process of completing the clinical training
requirement in Subsection 
58-70a-501.1
(1)(d), may engage in the practice of mental health
therapy if the physician assistant:
(a) meets the requirements described in Subsections 
58-70a-501.1
(1)(a) through (c);
(b) engages in the practice of mental health therapy under the supervision of:
(i) a mental health therapist who has been trained in and has at least two years of
practice experience in psychotherapy; or
(ii) a physician who is board certified in psychiatry; and
(c) engages in the practice of mental health therapy in accordance with rules made by
the division regarding the supervision described in Subsection (6)(b).
Section 8. 
 Coordinating S.B. 28 with S.B. 27 -- Omitting substantive changes --
Substantive amendments.
(1) It is the intent of the Legislature that this S.B. 28 shall only take effect if S.B. 27,
Physician Assistant Act Amendments, passes and becomes law.
(2) If this S.B. 28 and S.B. 27, Physician Assistant Act Amendments, both pass and
become law, it is the intent of the Legislature that:
(a) Subsection 58-70a-307(2)(c) shall be amended to read:
"(c) except as provided in Subsection 
58-70a-501.1
(4)(d) for a physician assistant
specializing in mental health care, engage in collaboration with a physician for the first 4,000
hours of the physician assistant's post-graduate clinical practice experience.";
(b) Subsection 58-70a-307(3)(a) shall be amended to read:
"(3) (a) Except as provided in Subsection 
58-70a-501.1
(4)(d) for a physician assistant
specializing in mental health care, a physician assistant who has more than 4,000 hours of
practice experience and less than 10,000 hours of practice experience shall enter into a written
collaborative agreement with:
(i) a physician; or
(ii) a licensed physician assistant with more than 10,000 hours of practice experience in
the same specialty as the physician assistant.";
(c) Subsection 
58-70a-501.1
(4)(d)(iii) shall be amended to read:
"(iii) The remaining clinical practice hours required under Subsection (4)(a) and not
received under Subsections (4)(d)(i) and (ii) shall be completed in collaboration as defined in
Section 58-70a-307 with a psychiatrist."; and
(d) the Office of Legislative Research and General Counsel prepare the Utah Code
database for publication in accordance with Subsections (1) and (2) of this coordination clause.